Basic Information
| Provider Information | |||||||||
| NPI: | 1801457890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNER BALANCE FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3319 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613133883 | ||||||||
| FaxNumber: | 5618025385 | ||||||||
| Practice Location | |||||||||
| Address1: | 3319 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613133883 | ||||||||
| FaxNumber: | 5618025385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2019 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | HINDS | ||||||||
| AuthorizedOfficialFirstName: | DIONNE | ||||||||
| AuthorizedOfficialMiddleName: | LAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7722490636 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INNER BALANCE FAMILY MEDICINE, LLC | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.