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General NPI Number Information
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NPI Number | 1417581521
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Entity Type | Organization
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Legal Business Name | MHC III
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 1665 DUNLAWTON AVE STE 107
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City | PORT ORANGE
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State | FL
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Zip | 32127-2920
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Country | US
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Telephone | 386-238-9069
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Fax |
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Provider Business Mailing Address
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Address Line | 31 LUPI CT STE 110
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City | PALM COAST
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State | FL
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Zip | 32137-4761
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Country | US
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Telephone | 912-585-4583
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL RICE
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Credential |
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Telephone | 912-585-4583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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