Provider Demographics
NPI:1609136985
Name:HOUSECALLS OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:HOUSECALLS OF SOUTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-786-9552
Mailing Address - Street 1:2261 NE 36TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7588
Mailing Address - Country:US
Mailing Address - Phone:954-786-9552
Mailing Address - Fax:954-786-9557
Practice Address - Street 1:2261 NE 36TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7588
Practice Address - Country:US
Practice Address - Phone:954-786-9552
Practice Address - Fax:954-786-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3316Medicare PIN
FLG10649Medicare UPIN