Provider Demographics
NPI:1225592603
Name:BACK IN ACTION MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:BACK IN ACTION MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-404-9102
Mailing Address - Street 1:2351 SW MARTIN HWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2351 SW MARTIN HWY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3222
Practice Address - Country:US
Practice Address - Phone:772-324-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99VRHOtherFLORIDA BLUE