Provider Demographics
NPI:1942637194
Name:FLORIDA PRACTICE &BENEFITS GROUP LLC
Entity Type:Organization
Organization Name:FLORIDA PRACTICE &BENEFITS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-316-0482
Mailing Address - Street 1:30 WINDING CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6773
Mailing Address - Country:US
Mailing Address - Phone:386-316-0482
Mailing Address - Fax:386-673-3324
Practice Address - Street 1:30 WINDING CREEK WAY
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6773
Practice Address - Country:US
Practice Address - Phone:386-299-1486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization