Provider Demographics
NPI:1689951808
Name:BIRD GALLOWAY HEALTH LLC
Entity Type:Organization
Organization Name:BIRD GALLOWAY HEALTH LLC
Other - Org Name:LOCATEL HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:786-422-7313
Mailing Address - Street 1:20900 NE 30TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2162
Mailing Address - Country:US
Mailing Address - Phone:305-370-3540
Mailing Address - Fax:305-935-1729
Practice Address - Street 1:7035 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2505
Practice Address - Country:US
Practice Address - Phone:786-422-8302
Practice Address - Fax:786-456-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH258373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008003200Medicaid
2133140OtherPK