Provider Demographics
NPI:1285393694
Name:PATIENT PROVIDER NETWORK LLC
Entity type:Organization
Organization Name:PATIENT PROVIDER NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-415-2308
Mailing Address - Street 1:5260 78TH AVE N UNIT 1562
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-8062
Mailing Address - Country:US
Mailing Address - Phone:727-415-2308
Mailing Address - Fax:
Practice Address - Street 1:1700 N DIXIE HWY STE 140
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1808
Practice Address - Country:US
Practice Address - Phone:727-415-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier