Provider Demographics
NPI:1043448715
Name:MIRACLE RESORT HEALTH INTERNATIONAL SPA INC.
Entity Type:Organization
Organization Name:MIRACLE RESORT HEALTH INTERNATIONAL SPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-423-0800
Mailing Address - Street 1:5400 S BISCAYNE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1932
Mailing Address - Country:US
Mailing Address - Phone:941-423-0800
Mailing Address - Fax:941-423-0232
Practice Address - Street 1:5400 S BISCAYNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1932
Practice Address - Country:US
Practice Address - Phone:941-423-0800
Practice Address - Fax:941-423-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty