Provider Demographics
NPI:1588199830
Name:PLANTATION HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PLANTATION HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-321-9501
Mailing Address - Street 1:7330 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1605
Mailing Address - Country:US
Mailing Address - Phone:954-321-9501
Mailing Address - Fax:954-321-9502
Practice Address - Street 1:7330 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1605
Practice Address - Country:US
Practice Address - Phone:954-321-9501
Practice Address - Fax:954-321-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty