1811121452 NPI number — ROBERT EID MDPA

Table of content: (NPI 1811121452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811121452 NPI number — ROBERT EID MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT EID MDPA
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:
1811121452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEY WEST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33045-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-293-3557
Provider Business Mailing Address Fax Number:
305-293-9983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 COLLEGE RD
Provider Second Line Business Practice Location Address:
C/O OPERATING ROOM
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-294-5531
Provider Business Practice Location Address Fax Number:
305-292-9196
Provider Enumeration Date:
05/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EID
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-293-3557

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  ME38704 , 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: 36309 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 065787500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".