Healthcare Provider Details

I. General information

NPI: 1649698580
Provider Name (Legal Business Name): POLLOCK & POLLOCK CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 PARK LN
JASPER FL
32052-6208
US

IV. Provider business mailing address

1124 PARK LN
JASPER FL
32052-6208
US

V. Phone/Fax

Practice location:
  • Phone: 386-623-1023
  • Fax:
Mailing address:
  • Phone: 386-623-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number9481124
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11180
License Number StateFL

VIII. Authorized Official

Name: DWIGHT POLLOCK
Title or Position: PRESIDENT
Credential:
Phone: 386-623-1023