Organization
BLANCA PEAK INPATIENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(973) 251-1132
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(973) 251-1132
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/05/2014
Last updated
12/09/2019
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