Provider Demographics
NPI:1891294856
Name:SYNERGY HEALTH GROUP LLC
Entity Type:Organization
Organization Name:SYNERGY HEALTH GROUP LLC
Other - Org Name:SYNERGY LIFESTYLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-721-0894
Mailing Address - Street 1:2735 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2548
Mailing Address - Country:US
Mailing Address - Phone:904-721-0849
Mailing Address - Fax:904-721-9449
Practice Address - Street 1:7828 COLLINS GROVE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-721-0894
Practice Address - Fax:904-721-9449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY HEALTH GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-06
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90169207RC0000X
FLME97437207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278421100Medicaid
FL18799100Medicaid