Provider Demographics
NPI:1265780720
Name:PORT ORANGE ACUPUNCTURE LLC
Entity type:Organization
Organization Name:PORT ORANGE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:386-314-3959
Mailing Address - Street 1:100 CESSNA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6969
Mailing Address - Country:US
Mailing Address - Phone:386-761-8818
Mailing Address - Fax:
Practice Address - Street 1:100 CESSNA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6969
Practice Address - Country:US
Practice Address - Phone:386-761-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38975261Q00000X
FLAP3008261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center