Provider Demographics
NPI:1154306157
Name:FIVE POINTS FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:FIVE POINTS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-995-0125
Mailing Address - Street 1:5607 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8769
Mailing Address - Country:US
Mailing Address - Phone:850-995-0125
Mailing Address - Fax:850-995-0465
Practice Address - Street 1:5607 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8769
Practice Address - Country:US
Practice Address - Phone:850-995-0125
Practice Address - Fax:850-995-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1039OtherHEALTH FIRST NETWORK
FL1039OtherHEALTH FIRST NETWORK