1972534139 NPI number — AMISUB NORTHRIDGE HOSPITAL ,INC.

Table of content: (NPI 1972534139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972534139 NPI number — AMISUB NORTHRIDGE HOSPITAL ,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMISUB NORTHRIDGE HOSPITAL ,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:
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:
1972534139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740754
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-0754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-982-2189
Provider Business Mailing Address Fax Number:
954-493-5061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 N DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33334-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-776-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  4139 , 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: 919683020 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0102571-00 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001207 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080092 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990194 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010257100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224058 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 284 . This is a "BCBS OF FLORIDA" identifier . This identifiers is of the category "OTHER".




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