Provider Demographics
NPI:1689064834
Name:PROVIDERS HEALTH ALLIANCE, LLC
Entity Type:Organization
Organization Name:PROVIDERS HEALTH ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCHNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:561-293-4305
Mailing Address - Street 1:11924 FOREST HILL BLVD STE 10A-138
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:561-293-4301
Mailing Address - Fax:561-828-3111
Practice Address - Street 1:12955 PALMS WEST DR STE 203
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9217
Practice Address - Country:US
Practice Address - Phone:561-231-5200
Practice Address - Fax:561-231-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty