MEDICARE: WELLINGTON FAMILY PRACTICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110872	OTHER	FL	HUMANA
2	2284893	OTHER	FL	AETNA
3	38490	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1043292659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON FAMILY PRACTICE INC

Provider Business Mailing Address
First Line	:	10131 W FOREST HILL BLVD
Second Line	:	SUITE 130
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6156
Country	:	US
Telephone Number	:	561-795-2878
Fax Number	:	561-795-0464

Provider Business Practice Location Address
First Line	:	10131 W FOREST HILL BLVD
Second Line	:	SUITE 130
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6156
Country	:	US
Telephone Number	:	561-795-2878
Fax Number	:	561-795-0464

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. JAMES C. POYER
Credential	:	PH.D.
Telephone Number	:	561-795-2878

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/22/2020

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Directions to “WELLINGTON FAMILY PRACTICE INC ” Practice Location

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