1356753255 NPI number — WHOLE FAMILY HEALTH CENTER

Table of content: (NPI 1356753255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356753255 NPI number — WHOLE FAMILY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLE FAMILY HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AIDS RESEARCH AND TREATMENT CENTER OF THE TREASURE COAST
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356753255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
827 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-6481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-925-8200
Provider Business Mailing Address Fax Number:
772-925-8199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 N US HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950-9125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-925-8402
Provider Business Practice Location Address Fax Number:
772-925-8403
Provider Enumeration Date:
05/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ANDRESS
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
772-925-8200

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH30417 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 605787 . This is a "HEALTHCARE CLINIC ESTABLISHMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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