Provider Demographics
NPI:1578362729
Name:PREVENTIVE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:PREVENTIVE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:386-585-4003
Mailing Address - Street 1:PO BOX 354733
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-4733
Mailing Address - Country:US
Mailing Address - Phone:386-585-4003
Mailing Address - Fax:386-597-7493
Practice Address - Street 1:50 LEANNI WAY UNIT A5
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4753
Practice Address - Country:US
Practice Address - Phone:386-585-4003
Practice Address - Fax:386-597-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty