Provider Demographics
NPI:1831791185
Name:PARTNERS FAMILY MEDICINE PRACTICE AND ADDICTION RECOVERY CENTER INC.
Entity type:Organization
Organization Name:PARTNERS FAMILY MEDICINE PRACTICE AND ADDICTION RECOVERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-905-0110
Mailing Address - Street 1:4453 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2066
Mailing Address - Country:US
Mailing Address - Phone:850-905-0110
Mailing Address - Fax:
Practice Address - Street 1:4453 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2066
Practice Address - Country:US
Practice Address - Phone:850-905-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARTNERS FAMILY MEDICINE PRACTICE & RECOVERY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty