Provider Demographics
NPI:1972251270
Name:MD-PRAC LLC
Entity type:Organization
Organization Name:MD-PRAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-245-5633
Mailing Address - Street 1:4662 SW BRADBURY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5563
Mailing Address - Country:US
Mailing Address - Phone:833-245-5633
Mailing Address - Fax:933-962-6213
Practice Address - Street 1:1860 SW FOUNTAINVIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4528
Practice Address - Country:US
Practice Address - Phone:833-245-5633
Practice Address - Fax:833-962-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty