1780970616 NPI number — FLORIDA EMERGENCY CONSULTANTS LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780970616 NPI number — FLORIDA EMERGENCY CONSULTANTS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA EMERGENCY CONSULTANTS LLP
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:
1780970616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMIT DR # 1367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-701-3381
Provider Business Mailing Address Fax Number:
231-922-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 W SAGAMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEWISTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33440-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-983-9121
Provider Business Practice Location Address Fax Number:
863-983-1809
Provider Enumeration Date:
06/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
DERIK
Authorized Official Middle Name:
K
Authorized Official Title or Position:
LLP MANAGING PARTNER
Authorized Official Telephone Number:
800-701-3381

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 277866101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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