Organization
COOP MANAGED HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LINDA KAY FULLER RN (PRESIDENT)
(704) 719-0161
Entity
Organization
Contact information
Practice address
5028 ASHLEY LAKE DRIVE, UNIT 331, BOYNTON BEACH, FL 33437
(704) 719-0161
Mailing address
5028 ASHLEY LAKE DR, UNIT 331, BOYNTON BEACH, FL 33437-3176
(704) 719-0161
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
RN 9245770
FL
Other
Enumeration date
01/24/2007
Last updated
08/08/2008
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