Provider Demographics
NPI:1871518365
Name:HUMANA MEDICAL PLAN INC
Entity type:Organization
Organization Name:HUMANA MEDICAL PLAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-270-2766
Mailing Address - Street 1:11701 MILLS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11701 MILLS DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4836
Practice Address - Country:US
Practice Address - Phone:305-270-2766
Practice Address - Fax:305-596-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH112683336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1072064OtherOTHER ID NUMBER-COMMERCIAL NUMBER