Provider Demographics
NPI:1831311810
Name:PALM HARBOR FAMILY PRACTICE AND WALK IN CLINIC PA
Entity Type:Organization
Organization Name:PALM HARBOR FAMILY PRACTICE AND WALK IN CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-445-6191
Mailing Address - Street 1:9 PINE CONE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8686
Mailing Address - Country:US
Mailing Address - Phone:386-445-6191
Mailing Address - Fax:
Practice Address - Street 1:9 PINE CONE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8686
Practice Address - Country:US
Practice Address - Phone:386-445-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty