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General NPI Number Information
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NPI Number | 1669785671
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH NETWORK LLC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 8403 BALM ST
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City | WEEKI WACHEE
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State | FL
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Zip | 34607
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Country | US
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Telephone | 352-596-7887
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Fax | 352-596-7886
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Provider Business Mailing Address
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Address Line | 8403 BALM ST
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City | WEEKI WACHEE
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State | FL
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Zip | 34607-4419
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Country | US
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Telephone | 352-596-7887
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Fax | 352-596-7886
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CANDACE KONEY
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Credential | M.D.
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Telephone | 352-596-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | ME90158
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License Number State | FL
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