Organization Active NPI

Wholistic Medicine Clinic, LLC

  • Clinic/Center
  • Fort Pierce, FL
National Provider Identifier
1750447405
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WHOLISTIC MEDICINE CLINIC, LLC
Practice address
2401 Frist Blvd
Suite 7
Fort Pierce, FL 34950-4839
Phone
(772) 467-9043
Fax
(772) 464-6478
NPI assigned
Dec 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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) 287-2677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2401 Frist Blvd
Suite 7
Fort Pierce, FL 34950-4839

Mailing address

2401 Frist Blvd
Suite 7
Fort Pierce, FL 34950-4839
Phone (772) 467-9043

Other identifiers 1

IdentifierTypeStateIssuer
24565OtherFLBLUECROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750447405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 FRIST BLVD",
            "address_2": "SUITE 7",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504839",
            "telephone_number": "772-467-9043",
            "fax_number": "772-464-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 FRIST BLVD",
            "address_2": "SUITE 7",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504839",
            "telephone_number": "772-467-9043",
            "fax_number": "772-464-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHOLISTIC MEDICINE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "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": "772-287-2677",
        "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": "24565",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.