# CLUB2,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629412515
- **Authorized official:** DR. PAUL ROEBUCK HENNING M.D (MEDICAL DIRECTOR)
- **Authorized official phone:** (850) 696-9556

## Contact information

- **Practice address:** 1230 CRANE COVE BLVD, GULF BREEZE, FL 32563-3191
- **Practice address phone:** (850) 934-6659
- **Mailing address:** 1175 MARY KATE DR, GULF BREEZE, FL 32563-5542
- **Mailing address phone:** (850) 934-6659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QE0002X | Emergency Care Clinic/Center | ME93462 | FL | Yes |

## Other

- **Enumeration date:** 04/22/2013
- **Last updated:** 04/22/2013