Provider Demographics
NPI:1871991240
Name:IPERFORMANCE CENTER
Entity type:Organization
Organization Name:IPERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARGAGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-460-2024
Mailing Address - Street 1:200 CALUSA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5753
Mailing Address - Country:US
Mailing Address - Phone:850-460-2024
Mailing Address - Fax:850-460-7987
Practice Address - Street 1:200 CALUSA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5753
Practice Address - Country:US
Practice Address - Phone:850-460-2024
Practice Address - Fax:850-460-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL735439OtherOPTUM HEALTH/UNITEDHEALTHCARE INDIVIDUAL
FLY91AWOtherBLUE CROSS BLUE SHIELD
FL6923846OtherCIGNA
FL14370OtherOPTUM HEALTH/UNITEDHEALTHCARE GROUP
FL1871991240OtherTRICARE
FL735439OtherOPTUM HEALTH/UNITEDHEALTHCARE INDIVIDUAL
FLIF717ZMedicare PIN