Provider Demographics
NPI:1205280260
Name:HEALTHSTONE PRIMARY CARE PARTNERS LLC
Entity type:Organization
Organization Name:HEALTHSTONE PRIMARY CARE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-559-6400
Mailing Address - Street 1:797 SUNFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2113
Mailing Address - Country:US
Mailing Address - Phone:954-559-6400
Mailing Address - Fax:
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-981-7060
Practice Address - Fax:954-983-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL16000050732OtherSTATE OF FLORIDA CORPORATION ID