Provider Demographics
NPI:1710583190
Name:OPTIONS HEALTH FAMILY PRACTICE
Entity Type:Organization
Organization Name:OPTIONS HEALTH FAMILY PRACTICE
Other - Org Name:OPTIONS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:AAPRN
Authorized Official - Phone:850-273-8450
Mailing Address - Street 1:101 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32456-7178
Mailing Address - Country:US
Mailing Address - Phone:850-273-8450
Mailing Address - Fax:423-803-4776
Practice Address - Street 1:256 CANAL STREET
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-273-8450
Practice Address - Fax:423-803-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC1F7OtherFLORIDA BLUE