NPIMap

Organization Active NPI

66101 Sunset Strip,LLC

  • Ambulatory Surgical Clinic/Center
  • Boca Raton, FL
National Provider Identifier
1235433749
Registry record updated Dec 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
22512 Issued in NJ
Legal business name
66101 SUNSET STRIP,LLC
Practice address
40 South East 5TH Street, Suite 406
Boca Raton, FL 33432
Phone
(561) 368-7118
Fax
(561) 368-7116
NPI assigned
Dec 28, 2010
Last updated
Dec 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2010

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

Authorized official

Name
Dr. Thomas Mednolia, MD
Title
VP
Phone
(336) 575-2833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 22512 NJ Primary

Addresses

Primary practice location

40 South East 5TH Street, Suite 406
Boca Raton, FL 33432

Mailing address

40 SE 5TH St Ste 406
Boca Raton, FL 33432-6003
Phone (561) 368-7118

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293494400000",
    "number": "1235433749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SE 5TH ST STE 406",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334326003",
            "telephone_number": "561-368-7118",
            "fax_number": "561-368-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SOUTH EAST 5TH STREET, SUITE 406",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "33432",
            "telephone_number": "561-368-7118",
            "fax_number": "561-368-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "66101 SUNSET STRIP,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A",
        "authorized_official_last_name": "MEDNOLIA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "336-575-2833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": "22512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; 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.