Early Intervention Specialists of Northwest Florida, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

RN3076242 Issued in FL

Legal business name

EARLY INTERVENTION SPECIALISTS OF NORTHWEST FLORIDA, LLC

Practice address

5170 12TH Ave
Malone, FL 32445-3426

Phone

(850) 209-5880

Fax

(866) 521-4620

NPI assigned

Mar 7, 2013

Last updated

Mar 7, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marcia S Thompson, RNNPI 1477697944

Title

Owner

Phone

(850) 209-5880

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marcia S Thompson, RN

  • Community Health Registered Nurse
  • Malone, FL
  • NPI 1477697944
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1063753572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 12TH AVE",
            "city": "MALONE",
            "state": "FL",
            "postal_code": "324453426",
            "telephone_number": "850-209-5880",
            "fax_number": "866-521-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5170 12TH AVE",
            "city": "MALONE",
            "state": "FL",
            "postal_code": "324453426",
            "telephone_number": "850-209-5880",
            "fax_number": "866-521-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARLY INTERVENTION SPECIALISTS OF NORTHWEST FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-07",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-209-5880",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "FL",
            "license": "RN3076242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810941900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• John Bertram Garrett IV, MSN, APRN, FNP-C
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• Michaela Janine Johnson, LPN
• Kelley Tew Kindelspire, APRN
• Malone Pharmacy LLC

• Early Intervention Provider Agency in Malone, FL
• Providers in Malone, FL by specialty
• Early Intervention Provider Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.