| Pura Vida Health Institute Llc | |
|
215 Sugartown Rd Wayne PA 19087-3137 | |
| (215) 806-6270 | |
| Not Available |
| Full Name | Pura Vida Health Institute Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 215 Sugartown Rd, Wayne, Pennsylvania |
| Authorized Official Name and Position | Christopher Mulholland (OWNER) |
| Authorized Official Contact | 2158066270 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pura Vida Health Institute Llc 215 Sugartown Rd Wayne PA 19087-3137 Ph: () - | Pura Vida Health Institute Llc 215 Sugartown Rd Wayne PA 19087-3137 Ph: (215) 806-6270 |
| NPI Number | 1588315865 |
|---|---|
| Provider Enumeration Date | 01/18/2022 |
| Last Update Date | 07/08/2022 |
| Medicare PECOS PAC ID | 4688061401 |
|---|---|
| Medicare Enrollment ID | O20220426002297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588315865 | NPI | - | NPPES |
| OS020055 | Other | PA | PENNSYLVANIA DEPARTMENT OF STATE - PROFESSIONAL LICENSING BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Christopher M Mulholland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528597549 PECOS PAC ID: 3870828403 Enrollment ID: I20190718000739 |
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