Healthcare Provider Details

I. General information

NPI: 1477715993
Provider Name (Legal Business Name): EASTERN MEDICINE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTERSON RD STE.# 1
HAINES CITY FL
33844-6261
US

IV. Provider business mailing address

280 PATTERSON RD STE.# 1
HAINES CITY FL
33844-6261
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-2900
  • Fax: 863-421-2990
Mailing address:
  • Phone: 863-421-2900
  • Fax: 863-421-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2523
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLMT 42039
License Number StateFL

VIII. Authorized Official

Name: LAN WANG
Title or Position: ACUPUNCTURIST
Credential:
Phone: 863-421-2900