Provider Demographics
NPI:1356620389
Name:1ST ASSIST OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:1ST ASSIST OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCLOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-978-0381
Mailing Address - Street 1:1419 BANYAN CIR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4976
Mailing Address - Country:US
Mailing Address - Phone:954-978-0381
Mailing Address - Fax:
Practice Address - Street 1:1419 BANYAN CIR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4976
Practice Address - Country:US
Practice Address - Phone:954-978-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102647363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588732374Medicare UPIN