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STEPHANE NAOUMOFF MD NPI 1477568186


NPI Information

NPI: 1477568186
Provider Name: STEPHANE NAOUMOFF MD

Doing Business As: RIVERSIDE FAMILY HEALTH PL

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 10D0991348

Address:
1395 N COURTENAY PKWY STE 100
MERRITT ISLAND, FL
ZIP 32953
Phone: (321) 453-5252
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STEPHANE NAOUMOFF MD is a primary care clinic center in Merritt Island, FL. STEPHANE NAOUMOFF MD NPI is 1477568186. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Riverside Family Health Pl.

The provider's business location address is:

1395 N COURTENAY PKWY STE 100
MERRITT ISLAND, FL
ZIP 32953-474
Phone: (321) 453-5252
Fax: (321) 453-5152

The provider's authorized official is Kimberly Naoumoff .
The authorized official title is Practice Manager and has the following contact phone number (321) 453-5252.

The CLIA number assigned to this NPI record is 10D0991348 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/30/2006 and was last updated on 1/30/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12083P0011XPreventive MedicineUndersea and Hyperbaric MedicineNo
2363AM0700XPhysician AssistantMedicalNo
3363LF0000XNurse PractitionerFamilyNo
4261QP2300XClinic/CenterPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1113538600MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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