Provider Demographics
NPI:1245496769
Name:BEST PRACTICE DISEASE MANAGEMENT, INC.
Entity type:Organization
Organization Name:BEST PRACTICE DISEASE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-242-9517
Mailing Address - Street 1:PO BOX 950666
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-0666
Mailing Address - Country:US
Mailing Address - Phone:407-942-0201
Mailing Address - Fax:407-842-0202
Practice Address - Street 1:3616 DERBY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6531
Practice Address - Country:US
Practice Address - Phone:540-774-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241541175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty