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General NPI Number Information
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NPI Number | 1972346062
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Entity Type | Organization
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Legal Business Name | YOUR HEALTH HOUSE CALLS FLORIDA LLC
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 1301 PLANTATION ISLAND DR S STE 303B
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-3117
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Country | US
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Telephone | 803-457-5129
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Fax |
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Provider Business Mailing Address
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Address Line | 111 DOCTOR CIR
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City | COLUMBIA
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State | SC
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Zip | 29203-6502
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Country | US
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Telephone | 803-487-5129
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW STAUB
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Credential |
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Telephone | 803-730-8910
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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 |
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License Number State |
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