1932361631 NPI number — CARESERVICES OF THE HEARTLAND LLC

Table of content: MRS. MARGIE GABIS PARKER FNP C (NPI 1629014808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932361631 NPI number — CARESERVICES OF THE HEARTLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARESERVICES OF THE HEARTLAND 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:
1932361631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 HIGH RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 101 AND 103
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33426-8725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-244-0220
Provider Business Mailing Address Fax Number:
561-244-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3710 CORPOREX PARK DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33619-1189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-630-4336
Provider Business Practice Location Address Fax Number:
813-864-1003
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOCHHAUSER
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-244-0220

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  6509037-01 , 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: 650903701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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