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General NPI Number Information
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NPI Number | 1104168095
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Entity Type | Organization
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Legal Business Name | LOW T CENTER
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 12889 EMERALD COAST PKWY W SUITE 107B
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-3243
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Country | US
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Telephone | 850-830-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 622 MOUNTAIN DR
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City | DESTIN
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State | FL
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Zip | 32541-2429
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Country | US
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Telephone | 850-830-3012
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. RICHARD CHERN
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Credential | MD
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Telephone | 850-830-3012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | ME95148
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME95148
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License Number State | FL
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