Provider Demographics
NPI:1720261076
Name:ST AUGUSTINE ACUPUNCTURE CENTRE INC
Entity Type:Organization
Organization Name:ST AUGUSTINE ACUPUNCTURE CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-806-1417
Mailing Address - Street 1:6349 SALADO RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7665
Mailing Address - Country:US
Mailing Address - Phone:904-806-1417
Mailing Address - Fax:866-493-3028
Practice Address - Street 1:6349 SALADO RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7665
Practice Address - Country:US
Practice Address - Phone:904-806-1417
Practice Address - Fax:866-493-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5056261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center