Provider Demographics
NPI:1629541859
Name:WELL CARE INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:WELL CARE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-296-8787
Mailing Address - Street 1:1920 PALM BEACH LAKES BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3506
Mailing Address - Country:US
Mailing Address - Phone:561-296-8787
Mailing Address - Fax:561-296-8788
Practice Address - Street 1:1920 PALM BEACH LAKES BLVD STE 212
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3506
Practice Address - Country:US
Practice Address - Phone:561-296-8787
Practice Address - Fax:561-296-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89634OtherBLUE CROSS BLUE SHIELD OF FL