1811001860 NPI number — THE OUTPATIENT CENTER, LLC

Table of content: (NPI 1811001860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811001860 NPI number — THE OUTPATIENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OUTPATIENT CENTER, LLC
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:
THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD.
Provider Other Organization Name Type Code:
4
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:
1811001860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2351S SEACREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33435-6759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-732-5900
Provider Business Mailing Address Fax Number:
561-732-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2531 SOUTH SEACREST BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-732-5900
Provider Business Practice Location Address Fax Number:
561-732-7667
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
JENETHA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
972-692-6745

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  944 , 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: 079186500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".