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Organization
WAY MEDICAL GROUP
Active
Organization
WAY MEDICAL GROUP
Active
Other names
The Way Medical Group LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY BOULDIN (CEO)
(321) 989-2187
Entity
Organization
Contact information
Practice address
4780 DAIRY RD, MELBOURNE, FL 32904-8482
(321) 989-2187
Mailing address
4780 DAIRY RD, MELBOURNE, FL 32904-8482
(321) 989-2187
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
246Z00000X
Other Specialist/Technologist
—
NULL
246Z00000X
Other Specialist/Technologist
—
—
251J00000X
Nursing Care Agency
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
261QR1100X
Research Clinic/Center
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
09/07/2022
Last updated
07/26/2023
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