Provider Demographics
NPI:1720388754
Name:BEACH HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BEACH HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:239-765-6000
Mailing Address - Street 1:6051 ESTERO BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-4348
Mailing Address - Country:US
Mailing Address - Phone:239-765-6000
Mailing Address - Fax:239-765-6008
Practice Address - Street 1:6051 ESTERO BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-4348
Practice Address - Country:US
Practice Address - Phone:239-765-6000
Practice Address - Fax:239-765-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty