Provider Demographics
NPI:1760510648
Name:MEDICAL STAFFING NETWORK, INC
Entity type:Organization
Organization Name:MEDICAL STAFFING NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-322-1300
Mailing Address - Street 1:901 YAMATO RD STE 901
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4497
Mailing Address - Country:US
Mailing Address - Phone:561-322-1300
Mailing Address - Fax:561-322-1445
Practice Address - Street 1:3301 NORTHLAND DR
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4939
Practice Address - Country:US
Practice Address - Phone:512-459-5656
Practice Address - Fax:512-459-8616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL STAFFING NETWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008145251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112913201Medicaid
TX001002296OtherMDCP
TX001002296OtherMDCP
TX677459Medicare Oscar/Certification