1255007100 NPI number — WHOLE FAMILY HEALTH CENTER, INC.

Table of content: (NPI 1255007100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255007100 NPI number — WHOLE FAMILY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLE FAMILY HEALTH CENTER, INC.
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:
Provider Other Organization Name Type Code:
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:
1255007100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2023
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:
1255 37TH ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-6550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-494-1770
Provider Business Practice Location Address Fax Number:
772-494-1774
Provider Enumeration Date:
08/20/2021

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: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022558504 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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