Provider Demographics
NPI:1255151429
Name:XTRA HEALTH, LLC
Entity type:Organization
Organization Name:XTRA HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:904-347-1700
Mailing Address - Street 1:12036 NW 1ST LN STE 200
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1123
Mailing Address - Country:US
Mailing Address - Phone:904-347-1700
Mailing Address - Fax:
Practice Address - Street 1:12036 NW 1ST LN STE 200
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1123
Practice Address - Country:US
Practice Address - Phone:904-347-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization