Provider Demographics
NPI:1962226381
Name:AVE MARIA PRIMARY CARE, LLC
Entity type:Organization
Organization Name:AVE MARIA PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-322-0917
Mailing Address - Street 1:5080 ANNUNCIATION CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9655
Mailing Address - Country:US
Mailing Address - Phone:239-322-0917
Mailing Address - Fax:239-658-5143
Practice Address - Street 1:5080 ANNUNCIATION CIR UNIT 103
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9655
Practice Address - Country:US
Practice Address - Phone:239-322-0917
Practice Address - Fax:239-658-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty