| Back In Action Medical Center Llc | |
|
2351 Sw Martin Hwy Palm City FL 34990-3222 | |
| (772) 324-9337 | |
| (772) 324-9347 |
| Full Name | Back In Action Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 2351 Sw Martin Hwy, Palm City, Florida |
| Authorized Official Name and Position | Robert Mclaughlin (OWNER) |
| Authorized Official Contact | 7723249337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back In Action Medical Center Llc 2351 Sw Martin Hwy Palm City FL 34990-3222 Ph: (772) 324-9337 | Back In Action Medical Center Llc 2351 Sw Martin Hwy Palm City FL 34990-3222 Ph: (772) 324-9337 |
| NPI Number | 1093183733 |
|---|---|
| Provider Enumeration Date | 09/11/2015 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/22/2024 |
| Medicare PECOS PAC ID | 7810272473 |
|---|---|
| Medicare Enrollment ID | O20170321002639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093183733 | NPI | - | NPPES |
| 99VRH | Other | FL | BCBS FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (Florida) | Primary |
| 363A00000X | Physician Assistant | (Florida) | Secondary |
| Provider Name | Mark D Polsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265400709 PECOS PAC ID: 8527962596 Enrollment ID: I20031121000168 |
| Provider Name | Michael Purificati |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1407108871 PECOS PAC ID: 5698181469 Enrollment ID: I20210303001655 |
| Provider Name | Misty V Gaddis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841852266 PECOS PAC ID: 7911308341 Enrollment ID: I20210623001517 |
| Provider Name | Corey A Stein |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235306150 PECOS PAC ID: 0446238323 Enrollment ID: I20230719003447 |
| Provider Name | Lara Lyn Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346414745 PECOS PAC ID: 4880097021 Enrollment ID: I20240415000242 |
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