Provider Demographics
NPI: | 1467487249 |
---|---|
Name: | NES OF FLORIDA |
Entity Type: | Organization |
Organization Name: | NES OF FLORIDA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT, CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VINCENT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MORRA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 800-377-8721 |
Mailing Address - Street 1: | PO BOX 403208 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30384-3208 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-377-8721 |
Mailing Address - Fax: | 304-523-2241 |
Practice Address - Street 1: | 1431 SW 1ST AVE STE 10 |
Practice Address - Street 2: | |
Practice Address - City: | OCALA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34474-4000 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-401-1453 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-11 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 72082A | Medicare ID - Type Unspecified | MEDICARE GROUP # |