Provider Demographics
NPI:1104168095
Name:LOW T CENTER
Entity type:Organization
Organization Name:LOW T CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-830-3012
Mailing Address - Street 1:622 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2429
Mailing Address - Country:US
Mailing Address - Phone:850-830-3012
Mailing Address - Fax:
Practice Address - Street 1:12889 EMERALD COAST PKWY W
Practice Address - Street 2:SUITE 107B
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3243
Practice Address - Country:US
Practice Address - Phone:850-830-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95148261QU0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care