1871900233 NPI number — CENTER FOR SKIN CANCER SURGERY, INC.

Table of content: (NPI 1871900233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871900233 NPI number — CENTER FOR SKIN CANCER SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR SKIN CANCER SURGERY, 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:
1871900233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8057 SPYGLASS HILL RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-8565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-428-4545
Provider Business Mailing Address Fax Number:
321-421-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7960 N WICKHAM RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-428-4545
Provider Business Practice Location Address Fax Number:
321-421-7898
Provider Enumeration Date:
07/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-428-4545

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  ME88079 , 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: RH580 . This is a "HFMG MA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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