1841212958 NPI number — LADIES FIRST CHOICE INC

Table of content: (NPI 1841212958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841212958 NPI number — LADIES FIRST CHOICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LADIES FIRST CHOICE 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:
1841212958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 TEMPLE TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33764-6649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-791-8801
Provider Business Mailing Address Fax Number:
727-530-4003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2337 BELLEAIR RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33764-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-535-4446
Provider Business Practice Location Address Fax Number:
727-796-3095
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAVLO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-535-4446

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09134 . This is a "WELLCARE HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: M0757 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 006497300 . 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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