=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699564856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LVG HEALTH GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2025
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1860 N PINE ISLAND RD STE 105
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33322-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-508-6036
-----------------------------------------------------
Fax | 689-304-2180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1860 N PINE ISLAND RD STE 105
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33322-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-508-6036
-----------------------------------------------------
Fax | 689-304-2180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE CONSULTANT
-----------------------------------------------------
Name | MRS. FARAH BAUDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-277-1621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------