Alpha Wave Health Centers LLC – Clinic/Center

Key facts

NPI: 1932745346
Entity type: Organization (NPI type 2)
Primary specialty: Clinic/Center 261Q00000X
Legal business name: ALPHA WAVE HEALTH CENTERS LLC
Practice address: 101 E Town PL Ste 100
St Augustine, FL 32092-2726
Phone: (386) 763-1400
NPI assigned: Nov 20, 2019
Organization subpart: No

Authorized official

Name: Goran Mladen
Title: Owner
Phone: (386) 871-1975

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinic/Center	261Q00000X			Yes

Addresses

Primary practice location

101 E Town PL Ste 100
St Augustine, FL 32092-2726

Mailing address

101 E Town PL Ste 100
St Augustine, FL 32092-2726
Phone (386) 763-1400

Other practice location 1

4120 US Highway 27
Unit 500
Leesburg, FL 34748
Phone (352) 816-1901

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 20, 2019.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1932745346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E TOWN PL STE 100",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320922726",
            "telephone_number": "386-763-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E TOWN PL STE 100",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320922726",
            "telephone_number": "386-763-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4120 US Highway 27",
            "address_2": "Unit 500",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "34748",
            "country_code": "US",
            "telephone_number": "352-816-1901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALPHA WAVE HEALTH CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "MLADEN",
        "authorized_official_first_name": "GORAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-871-1975"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

All providers in St Augustine, FL · Clinic/Center in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.