| Amethyst Wellness Llc | |
|
145 Cypress Point Pkwy Suite 208b Palm Coast FL 32164-8426 | |
| (386) 503-7950 | |
| Not Available |
| Full Name | Amethyst Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 145 Cypress Point Pkwy, Palm Coast, Florida |
| Authorized Official Name and Position | Amy Coopersmith (OWNER) |
| Authorized Official Contact | 3865037950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amethyst Wellness Llc 51 Renworth Ln Palm Coast FL 32164-6627 Ph: (386) 503-7950 | Amethyst Wellness Llc 145 Cypress Point Pkwy Suite 208b Palm Coast FL 32164-8426 Ph: (386) 503-7950 |
| NPI Number | 1376900019 |
|---|---|
| Provider Enumeration Date | 01/26/2016 |
| Last Update Date | 02/08/2016 |
| Medicare PECOS PAC ID | 8820397847 |
|---|---|
| Medicare Enrollment ID | O20160426001135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376900019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 9242220 (Florida) | Primary |
| Provider Name | Amy L Coopersmith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083606503 PECOS PAC ID: 2961701982 Enrollment ID: I20160426001492 |
| Provider Name | Jerald Glenn Coopersmith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902821044 PECOS PAC ID: 3375955032 Enrollment ID: I20201222001273 |
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