Provider Demographics
NPI:1477715993
Name:EASTERN MEDICINE HEALTH CENTER
Entity Type:Organization
Organization Name:EASTERN MEDICINE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-421-2900
Mailing Address - Street 1:280 PATTERSON RD
Mailing Address - Street 2:STE.# 1
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6261
Mailing Address - Country:US
Mailing Address - Phone:863-421-2900
Mailing Address - Fax:863-421-2990
Practice Address - Street 1:280 PATTERSON RD
Practice Address - Street 2:STE.# 1
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6261
Practice Address - Country:US
Practice Address - Phone:863-421-2900
Practice Address - Fax:863-421-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2523171100000X
FLLMT 42039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty