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General NPI Number Information
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NPI Number | 1780458554
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Entity Type | Organization
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Legal Business Name | THAIP MEDICAL/COMPLEXITY CARE LLC
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 336 WILSHIRE BLVD STE 238-120
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City | CASSELBERRY
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State | FL
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Zip | 32707-5370
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Country | US
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Telephone | 865-213-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 336 WILSHIRE BLVD STE 238-120
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City | CASSELBERRY
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State | FL
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Zip | 32707-5370
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Country | US
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Telephone | 865-213-2834
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Fax | 835-213-5169
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. JACOB READ
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Credential | PMHNP-BC
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Telephone | 406-860-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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