Provider Demographics
NPI:1003398520
Name:PROACTIVE MEDICAL SOLUTIONS PLLC
Entity Type:Organization
Organization Name:PROACTIVE MEDICAL SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:SCHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-456-4407
Mailing Address - Street 1:17808 KEY VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1040
Mailing Address - Country:US
Mailing Address - Phone:646-456-4407
Mailing Address - Fax:888-254-2756
Practice Address - Street 1:17808 KEY VISTA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1040
Practice Address - Country:US
Practice Address - Phone:646-456-4407
Practice Address - Fax:888-254-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14167261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1326122813OtherINDIVIDUAL NPI