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General NPI Number Information
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NPI Number | 1770764045
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Entity Type | Organization
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Legal Business Name | PROACTIVE MEDICAL ALLIANCE
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 3769 TOM JOHN LN
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City | TALLAHASSEE
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State | FL
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Zip | 32309-6747
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Country | US
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Telephone | 850-893-2245
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Fax | 888-843-1909
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Provider Business Mailing Address
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Address Line | 2910 KERRY FOREST PKWY D4-02
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City | TALLAHASSEE
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State | FL
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Zip | 32309-6892
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Country | US
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Telephone | 850-893-2245
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Fax | 888-843-1909
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLIE HOY
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Credential |
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Telephone | 850-893-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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