Wholistic Medicine Clin

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WHOLISTIC MEDICINE CLIN

Practice address

1405 SE Goldtree Dr
Suite D
Port St Lucie, FL 34952-7563

Phone

(772) 335-5022

Fax

(772) 335-5029

NPI assigned

Dec 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. William G Tye III

Title

Managing Partner

Phone

(772) 335-5022

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1619033362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 SE GOLDTREE DR",
            "address_2": "SUITE D",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527563",
            "telephone_number": "772-335-5022",
            "fax_number": "772-335-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 SE GOLDTREE DR",
            "address_2": "SUITE D",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527563",
            "telephone_number": "772-335-5022",
            "fax_number": "772-335-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHOLISTIC MEDICINE CLIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "TYE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "772-335-5022",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "94821",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bri'Anne M White
• Jessica White, OTR
• Kenneth Ray White, PH.D.
• Laurel Ann White
• Shane Donald Whiteley, DC
• Wickshire Port St. Lucie
• Dennis Darnell Wideman II
• Alex Wilburn, LPTA
• Brandon Matthew Wildermuth, PHARMD
• Stacey Wilfork, RN

• Clinic/Center in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.