1932328861 NPI number — KAREN M. WALDROP, P.A.

Table of content: (NPI 1932328861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932328861 NPI number — KAREN M. WALDROP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN M. WALDROP, P.A.
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:
1932328861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6039 COLLINS AVENUE
Provider Second Line Business Mailing Address:
STE 811
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-2251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-599-4185
Provider Business Mailing Address Fax Number:
800-697-1979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
437 W. 41ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-599-4185
Provider Business Practice Location Address Fax Number:
800-697-1979
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALDROP
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-599-4185

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  SA6628 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100528500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890509600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024711800 . 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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