Provider Demographics
NPI:1659501575
Name:BLOCK MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:BLOCK MEDICAL CONSULTING LLC
Other - Org Name:THE CENTER FOR HEALTH CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-528-2801
Mailing Address - Street 1:3511 WEDGEWOOD LN
Mailing Address - Street 2:PO BOX 107
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7187
Mailing Address - Country:US
Mailing Address - Phone:352-528-2801
Mailing Address - Fax:352-528-3824
Practice Address - Street 1:11834 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9340
Practice Address - Country:US
Practice Address - Phone:352-528-2801
Practice Address - Fax:352-528-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE76481Medicare UPIN