Provider Demographics
NPI:1952964132
Name:KOLBE CLINIC OF FLORIDA, LLC
Entity Type:Organization
Organization Name:KOLBE CLINIC OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WAINSCOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:850-904-2277
Mailing Address - Street 1:1830 MONTCLAIR RD STE A
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2645
Mailing Address - Country:US
Mailing Address - Phone:850-904-2277
Mailing Address - Fax:205-618-9706
Practice Address - Street 1:8734 ORTEGA PARK DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4139
Practice Address - Country:US
Practice Address - Phone:850-904-2277
Practice Address - Fax:205-618-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty