MEDICARE: GO CHECKPOINT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1063938454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO CHECKPOINT

Provider Business Mailing Address
First Line	:	5203 LA SALLE ST APT A
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-5029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5203 LA SALLE ST APT A
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-5029
Country	:	US
Telephone Number	:	772-925-9435
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANITHRA MINUS
Credential	:
Telephone Number	:	772-925-9435

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/17/2017

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Directions to “GO CHECKPOINT ” Practice Location

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