1780649194 NPI number — NOVA SOUTHEASTERN UNIVERSITY, INC.

Table of content: (NPI 1780649194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780649194 NPI number — NOVA SOUTHEASTERN UNIVERSITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA SOUTHEASTERN UNIVERSITY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780649194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 S UNIVERSITY DR
Provider Second Line Business Mailing Address:
ASSEMBLY BUILDING II, SUITE 202
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33328-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-262-4399
Provider Business Mailing Address Fax Number:
954-262-1172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 S UNIVERSITY DR
Provider Second Line Business Practice Location Address:
ASSEMBLY BUILDING II, SUITE 202
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33328-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-262-4399
Provider Business Practice Location Address Fax Number:
954-262-1172
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLLER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-262-4399

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS2443 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OS 2443 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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