Provider Demographics
NPI:1558577619
Name:PROJECT HEALTH INC
Entity Type:Organization
Organization Name:PROJECT HEALTH INC
Other - Org Name:LANGLEY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-793-5900
Mailing Address - Street 1:1425 S US HWY. 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5135
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:352-793-8050
Practice Address - Street 1:1389 S US HWY 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5135
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:352-793-9558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0289672291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030649500Medicaid
FL10D0289672OtherCLIA
FL99022OtherBLUE CROSS BLUE SHIELD
FL=========OtherTAX ID NUMBER
FLE9062Medicare PIN