Provider Demographics
NPI:1285357921
Name:AZOVA CARE GROUP (FL), PLLC
Entity type:Organization
Organization Name:AZOVA CARE GROUP (FL), PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EBERTING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-692-9682
Mailing Address - Street 1:144 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1666
Mailing Address - Country:US
Mailing Address - Phone:801-815-7342
Mailing Address - Fax:
Practice Address - Street 1:144 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1666
Practice Address - Country:US
Practice Address - Phone:801-815-7342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No333600000XSuppliersPharmacy