Organization
WHOLISTIC MEDICINE CLIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G TYE III (MANAGING PARTNER)
(772) 335-5022
Entity
Organization
Contact information
Practice address
1405 SE GOLDTREE DR, SUITE D, PORT ST LUCIE, FL 34952-7563
(772) 335-5022
(772) 335-5029
Mailing address
1405 SE GOLDTREE DR, SUITE D, PORT ST LUCIE, FL 34952-7563
(772) 335-5022
(772) 335-5029
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94821
BLUECROSS BLUE SHIELD
FL
Enumeration date
12/28/2006
Last updated
09/08/2008
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