Provider Demographics
NPI:1467068817
Name:HEALTH COACH DIRECT PRIMARY CARE PRACTICE PLLC
Entity Type:Organization
Organization Name:HEALTH COACH DIRECT PRIMARY CARE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-818-4151
Mailing Address - Street 1:12300 ALTERNATE A1A STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2206
Mailing Address - Country:US
Mailing Address - Phone:561-723-6019
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A STE 106
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2206
Practice Address - Country:US
Practice Address - Phone:561-723-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health