Provider Demographics
NPI:1073201638
Name:BO WLMC LLC
Entity Type:Organization
Organization Name:BO WLMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-467-4431
Mailing Address - Street 1:6100 GREENLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2626
Mailing Address - Country:US
Mailing Address - Phone:904-467-4431
Mailing Address - Fax:904-615-9966
Practice Address - Street 1:6100 GREENLAND RD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2626
Practice Address - Country:US
Practice Address - Phone:904-467-4431
Practice Address - Fax:904-615-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty