Provider Demographics
NPI:1679743454
Name:ADVANCED PRACTICE CLINIC LLC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-892-2464
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-0184
Mailing Address - Country:US
Mailing Address - Phone:850-892-2464
Mailing Address - Fax:850-892-2138
Practice Address - Street 1:1184 CIRCLE DR STE B
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-2599
Practice Address - Country:US
Practice Address - Phone:850-892-2464
Practice Address - Fax:850-892-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7312Medicare UPIN