Provider Demographics
NPI:1174924955
Name:DR. CHARLIE WARE AP, LLC
Entity type:Organization
Organization Name:DR. CHARLIE WARE AP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-498-4483
Mailing Address - Street 1:2632 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4857
Mailing Address - Country:US
Mailing Address - Phone:954-458-5999
Mailing Address - Fax:954-458-5990
Practice Address - Street 1:2632 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4857
Practice Address - Country:US
Practice Address - Phone:954-458-5999
Practice Address - Fax:954-458-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3999711OtherCOVENTRY HEALTH CARE OF FLORIDA
FLC00E6OtherBLUE CROSS BLUE SHIELD OF FLORIDA