1811954340 NPI number — PAVILION FOR WOMEN'S CARE LLC

Table of content: (NPI 1811954340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811954340 NPI number — PAVILION FOR WOMEN'S CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAVILION FOR WOMEN'S CARE 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:
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:
1811954340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 863393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-3393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-595-6488
Provider Business Mailing Address Fax Number:
305-595-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 SW 124TH AVE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33183-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-595-6488
Provider Business Practice Location Address Fax Number:
305-595-3532
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
305-264-5252

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39082 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: L03000001549 . This is a "CORPOORATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269223600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018236900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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