Provider Demographics
NPI:1043292659
Name:WELLINGTON FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:WELLINGTON FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:POYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-795-2878
Mailing Address - Street 1:10131 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6156
Mailing Address - Country:US
Mailing Address - Phone:561-795-2878
Mailing Address - Fax:561-795-0464
Practice Address - Street 1:10131 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6156
Practice Address - Country:US
Practice Address - Phone:561-795-2878
Practice Address - Fax:561-795-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110872OtherHUMANA
FL2284893OtherAETNA
FL38490OtherBCBS
FL2284893OtherAETNA
FLK2862Medicare ID - Type UnspecifiedGROUP ID