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General NPI Number Information
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NPI Number | 1578362729
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Entity Type | Organization
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Legal Business Name | PREVENTIVE HEALTHCARE SERVICES
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 50 LEANNI WAY UNIT A5
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City | PALM COAST
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State | FL
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Zip | 32137-4753
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Country | US
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Telephone | 386-585-4003
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Fax | 386-597-7493
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Provider Business Mailing Address
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Address Line | PO BOX 354733
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City | PALM COAST
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State | FL
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Zip | 32135-4733
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Country | US
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Telephone | 386-585-4003
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Fax | 386-597-7493
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Authorized Official
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Title or Position | CEO
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Name | BILLIE JONES
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Credential | RDCS
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Telephone | 386-585-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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