Provider Demographics
NPI:1770764045
Name:PROACTIVE MEDICAL ALLIANCE
Entity type:Organization
Organization Name:PROACTIVE MEDICAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-893-2245
Mailing Address - Street 1:2910 KERRY FOREST PKWY
Mailing Address - Street 2:D4-02
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6892
Mailing Address - Country:US
Mailing Address - Phone:850-893-2245
Mailing Address - Fax:888-843-1909
Practice Address - Street 1:3769 TOM JOHN LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-6747
Practice Address - Country:US
Practice Address - Phone:850-893-2245
Practice Address - Fax:888-843-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management