| |
10140 W Forest Hill Blvd Wellington FL 33414-6111 | |
(561) 798-7350 | |
(561) 798-7354 |
Full Name | |
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Speciality | Clinic/center |
Location | 10140 W Forest Hill Blvd, Wellington, Florida |
Authorized Official Name and Position | Jordan Litten (PRESIDENT) |
Authorized Official Contact | 5617399674 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2828 S Seacrest Blvd Suite 202 Boynton Beach FL 33435-7944 Ph: (561) 739-9674 | 10140 W Forest Hill Blvd Wellington FL 33414-6111 Ph: (561) 798-7350 |
NPI Number | 1831185982 |
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Provider Enumeration Date | 09/23/2005 |
Last Update Date | 09/18/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831185982 | NPI | - | NPPES |
274204700 | Medicaid | FL | |
V2825 | Other | FL | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | HCC4567 (Florida) | Primary |
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