Provider Demographics
NPI:1427277292
Name:POWELL HEALTH SOLUTIONS CORP
Entity type:Organization
Organization Name:POWELL HEALTH SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CECILLE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-948-4701
Mailing Address - Street 1:17100 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3102
Mailing Address - Country:US
Mailing Address - Phone:305-948-4701
Mailing Address - Fax:305-948-8591
Practice Address - Street 1:17100 NE 19TH AVE
Practice Address - Street 2:#125
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3102
Practice Address - Country:US
Practice Address - Phone:305-948-4701
Practice Address - Fax:305-948-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG88943Medicare UPIN
FLK6524Medicare ID - Type UnspecifiedGROUP