Healthcare Provider Details

I. General information

NPI: 1114146792
Provider Name (Legal Business Name): COACH COMP AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CONGRESS AVE STE 110
WEST PALM BEACH FL
33401-2933
US

IV. Provider business mailing address

400 N CONGRESS AVE STE 110
WEST PALM BEACH FL
33401-2933
US

V. Phone/Fax

Practice location:
  • Phone: 561-640-7505
  • Fax: 561-640-7506
Mailing address:
  • Phone: 561-640-7505
  • Fax: 561-640-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 75552
License Number StateFL

VIII. Authorized Official

Name: DR. SIMON ASHI
Title or Position: DIRECTOR
Credential:
Phone: 561-640-7505