LEGACY ADVANCED HEALTH LLC (NPI# 1538651112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538651112 |
| Entity Type | Organization |
| Organization Name | LEGACY ADVANCED HEALTH LLC |
| Other Organization Name | LEGACY ADVANCED HEALTH |
| Practice Address |
9864 Grand Verde Way Apt 1507 Boca Raton FL 33428-3524 |
| Practice Telephone | 5615635446 |
| Mailing Telephone | 5615635446 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |
| Authorized Official Name | PAMELA DIANA MANNING (OWNER/PRACTITIONER) |
| Authorized Official Telephone | 5615635446 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | FL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Legacy Advanced Health | Former Legal Business Name - Organization |
| Street Address |
9864 GRAND VERDE WAY APT 1507 |
| City | BOCA RATON |
| State | FL |
| Zip Code | 33428-3524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477065316 | Pamela Manning | Nurse Practitioner | 9864 Grand Verde Way Apt 1507, Boca Raton, FL 33428 | 2017-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174016604 | Eliane Dos Santos Lamarche | Behavior Technician | 11514 Country Sound Ct, Boca Raton, FL 33428 | 2018-06-09 |
| 1447740840 | Wilzade Joseph | Assisted Living Facility | 22319 Sw 65th Ave, Boca Raton, FL 33428 | 2018-05-11 |
| 1912428624 | Carole Mandat | Assistant Behavior Analyst | 11083 Baybreeze Way, Boca Raton, FL 33428 | 2017-07-03 |
| 1679025571 | Tam Thu Tran | Physician Assistant | 22864 Neptune Road, Boca Raton, FL 33428 | 2016-10-27 |
| 1922458355 | Zurab Akakievich Iosava | Specialist/Technologist, Other | 21644 State Road 7. (hwy 441), Boca Raton, FL 33428 | 2016-06-16 |
| 1497125280 | Robert Jay Drimmer | Internal Medicine | 21357 Bridgeview Drive, Boca Raton, FL 33428 | 2015-10-06 |
| 1710391966 | Pathway 2 Recovery Gold Coast | Clinic/Center | 23116a Sandal Foot Plaza Drive, Boca Raton, FL 33428 | 2014-06-16 |
| 1134564727 | Mary Margaret Spitzer | Nurse Practitioner | 9980 Central Park Blvdn, Boca Ration, FL 33428 | 2013-05-08 |
| 1619312816 | Alan Wasserman | Dentist | 22053 S.r. 7, Boca Raton, FL 33428 | 2013-05-02 |
| 1114361235 | Dermpartners Inc | Dermatology | 21020 State Rd 7, Suite 120, Boca Raton, FL 33428 | 2013-04-19 |
| Find all providers in zip 33428 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1063078772 | The Health Institute, LLC. | General Practice | 6699 N Federal Hwy Ste 200, Boca Raton, FL 33487-1660 | 2019-05-17 |
| 1740792126 | My Md Urgent Care LLC | General Practice | 9834 Glades Rd Ste C5, Boca Raton, FL 33434-3981 | 2017-10-25 |
| 1265941710 | Marilyne Etienne | General Practice | 9235 Sw 2nd St, Boca Raton, FL 33428-4509 | 2017-09-28 |
| 1144673294 | Dar Medical Group LLC | General Practice | 6031 Town Colony Dr, Unit 113, Boca Raton, FL 33433-1949 | 2016-07-13 |
| 1598127516 | 24 Hr Virtual Md, LLC | General Practice | 701 Park of Commerce Blvd Ste 301, Boca Raton, FL 33487-3604 | 2016-03-29 |
| 1881026920 | Max Citrin | General Practice | 2061 Nw Boca Raton Blvd, Suite 106, Boca Raton, FL 33431-7411 | 2013-07-31 |
| 1386916732 | Arvid John Peterson | General Practice | 1400 Tamarind Way, Boca Raton, FL 33486 | 2012-02-01 |
| 1740551498 | Us Medical Care Inc | General Practice | 190 Glades Rd Ste E, Boca Raton, FL 33432-1642 | 2012-01-25 |
| 1548561574 | Medical Specialists Primary and Urgent Care Facility Inc | General Practice | 3251 N Federal Hwy, Boca Raton, FL 33431-6001 | 2010-11-08 |
| Find all providers in BOCA RATON | ||||
| City | BOCA RATON |
| Zip Code | 33428 |
Please comment or provide details below to improve the information on LEGACY ADVANCED HEALTH LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.