Club2,LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

License

ME93462 Issued in FL

Legal business name

CLUB2,LLC

Practice address

1230 Crane Cove Blvd
Gulf Breeze, FL 32563-3191

Phone

(850) 934-6659

NPI assigned

Apr 22, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Paul Roebuck Henning, M.D

Title

Medical Director

Phone

(850) 696-9556

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1629412515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 MARY KATE DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325635542",
            "telephone_number": "850-934-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 CRANE COVE BLVD",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633191",
            "telephone_number": "850-934-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB2,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-22",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "HENNING",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ROEBUCK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-696-9556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "FL",
            "license": "ME93462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Care Clinic/Center in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Emergency Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.