Provider Demographics
NPI:1538820667
Name:LOGIQUE MEDICAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:LOGIQUE MEDICAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:LAFAILLE
Authorized Official - Last Name:LAFAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:561-374-2472
Mailing Address - Street 1:1325 S CONGRESS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5874
Mailing Address - Country:US
Mailing Address - Phone:561-374-2472
Mailing Address - Fax:
Practice Address - Street 1:1325 S CONGRESS AVE STE 207
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5874
Practice Address - Country:US
Practice Address - Phone:561-374-2472
Practice Address - Fax:561-437-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104011300Medicaid