1851422372 NPI number — SEQUELCARE OF FLORIDA LLC

Table of content: LAUREN MARY MCILVANIE (NPI 1407599475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851422372 NPI number — SEQUELCARE OF FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEQUELCARE OF FLORIDA 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:
6
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:
1851422372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3491 GANDY BLVD N
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PINELLAS PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33781-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-547-0607
Provider Business Mailing Address Fax Number:
727-547-6752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3491 GANDY BLVD N
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PINELLAS PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33781-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-547-0607
Provider Business Practice Location Address Fax Number:
727-547-6752
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
207-712-4393

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  100001014 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 100001014 , 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: 281413 . This is a "AMERIGROUP OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 550560 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC10073 . This is a "CLINIC LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 076079000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 793876000 . This is a "MAGELLAN BEHAVORIAL HEALT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 913829300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075937600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 076699200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33781 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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