| Revive Transitional Care And In Home Primary Medicine, Llc | |
|
900 Springwood Dr Orlando FL 32839-1318 | |
| (407) 429-1065 | |
| Not Available |
| Full Name | Revive Transitional Care And In Home Primary Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 900 Springwood Dr, Orlando, Florida |
| Authorized Official Name and Position | Maribel Palmer (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4074291065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Transitional Care And In Home Primary Medicine, Llc 900 Springwood Dr Orlando FL 32839-1318 Ph: (407) 429-1065 | Revive Transitional Care And In Home Primary Medicine, Llc 900 Springwood Dr Orlando FL 32839-1318 Ph: (407) 429-1065 |
| NPI Number | 1851096796 |
|---|---|
| Provider Enumeration Date | 03/31/2023 |
| Last Update Date | 03/31/2023 |
| Medicare PECOS PAC ID | 3870950868 |
|---|---|
| Medicare Enrollment ID | O20230607000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851096796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark A Bobek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962489195 PECOS PAC ID: 8426041138 Enrollment ID: I20090527000540 |
| Provider Name | Alan John De La Vina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699418483 PECOS PAC ID: 3173970555 Enrollment ID: I20231107000154 |
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