PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC
NPI 1376072181
Clinic/Center - Multi-Specialty in Palm City, FL
- Organization
- Clinic/Center
- Multi-Specialty
About PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC
This page provides the complete NPI Profile along with additional information for Pro Performance Anti Aging And Pharmaceutical Supplementation Llc, a provider established in Palm City, Florida operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1376072181 assigned on June 2017. The practitioner's primary taxonomy code is 261QM1300X with license number OS10791 (FL). The provider is registered as an organization and their NPI record was last updated 4 years ago. Pro Performance Anti Aging And Pharmaceutical Supplementation Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Mr. Domenic Iacovone (President)
- NPI
- 1376072181 Verify this NPI
- Provider Name
- PRO PERFORMANCE ANTI AGING AND PHARMACEUTICAL SUPPLEMENTATION LLC
- Entity Type
- Organization
- Location Address
- 4865 SW GOLFSIDE DR PALM CITY, FL 34990
- Location Phone
- (772) 631-1563
- Location Fax
- (772) 463-2344
- Mailing Address
- 4865 SW GOLFSIDE DR PALM CITY, FL 34990
- Mailing Phone
- (772) 631-1563
- Mailing Fax
- (772) 463-2344
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-06-2017
- Last Update Date
- 07-21-2022
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
- License No.
- OS10791
- License State
- FL
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | OS10791 (FL) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| OS10791 | OTHER (01) | FL | GROUP PRACTICE SPECIALITY |
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1376072181, enumerated as an "organization" on June 06, 2017.
The provider is located at 4865 SW GOLFSIDE DR PALM CITY, FL 34990 and the phone number is (772) 631-1563.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
