Organization
WHOLISTIC MEDICINE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G TYE III (MANAGING PARTNER)
(772) 287-2677
Entity
Organization
Contact information
Practice address
2401 FRIST BLVD, SUITE 7, FORT PIERCE, FL 34950-4839
(772) 467-9043
(772) 464-6478
Mailing address
2401 FRIST BLVD, SUITE 7, FORT PIERCE, FL 34950-4839
(772) 467-9043
(772) 464-6478
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24565
BLUECROSS BLUE SHIELD
FL
Enumeration date
12/28/2006
Last updated
08/22/2020
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