Provider Demographics
NPI:1689663205
Name:COMPREHENSIVE HEALTH CENTER, LLC.
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTH CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-688-0811
Mailing Address - Street 1:650 NW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2529
Mailing Address - Country:US
Mailing Address - Phone:305-688-0811
Mailing Address - Fax:305-688-6304
Practice Address - Street 1:650 NW 120TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2529
Practice Address - Country:US
Practice Address - Phone:305-688-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060722301Medicaid
FL98881OtherBLUE CROSS BLUE SHIELD
FL98881OtherBLUE CROSS BLUE SHIELD