Provider Demographics
NPI:1912180308
Name:HOLISTIC MEDICAL CENTER OF FORT PIERCE LLC
Entity Type:Organization
Organization Name:HOLISTIC MEDICAL CENTER OF FORT PIERCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEORGIADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-621-7772
Mailing Address - Street 1:2401 FRIST BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4839
Mailing Address - Country:US
Mailing Address - Phone:772-621-7772
Mailing Address - Fax:
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-621-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty