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General NPI Number Information
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NPI Number | 1154487874
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Entity Type | Organization
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Legal Business Name | WHOLISTIC MEDICINE CLINIC OF PALM BEACH GARDENS, LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3385 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4328
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Country | US
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Telephone | 561-624-9360
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Fax |
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Provider Business Mailing Address
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Address Line | 3385 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4328
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Country | US
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Telephone | 561-624-9360
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. WILLIAM G TYE III
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Credential |
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Telephone | 772-287-2677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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