Provider Demographics
NPI:1992313472
Name:ATHENA MEDICAL LLC
Entity type:Organization
Organization Name:ATHENA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-314-8202
Mailing Address - Street 1:9050 PINES BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6402
Mailing Address - Country:US
Mailing Address - Phone:954-314-8202
Mailing Address - Fax:954-842-4347
Practice Address - Street 1:45 W 17TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6121
Practice Address - Country:US
Practice Address - Phone:954-314-8202
Practice Address - Fax:954-842-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty