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General NPI Number Information
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NPI Number | 1730433590
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Entity Type | Organization
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Legal Business Name | ENVIRONMENTAL CONCEPTS AND SERVICES
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 3506 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-1964
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Country | US
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Telephone | 863-687-9900
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Fax | 863-683-9180
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Provider Business Mailing Address
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Address Line | 3506 LAKELAND HILLS BLVD.
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City | LAKELAND
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State | FL
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Zip | 33805
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Country | US
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Telephone | 863-687-9900
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Fax | 863-683-9180
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DOROTHY LYNN DUGIE
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Credential |
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Telephone | 863-687-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1053AD511200
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License Number State | FL
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