Provider Demographics
NPI:1003109315
Name:ADVANCED PEDIATRIC MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED PEDIATRIC MANAGEMENT, LLC
Other - Org Name:MARTIN COUNTY PPEC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-288-6466
Mailing Address - Street 1:310 SW OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2007
Mailing Address - Country:US
Mailing Address - Phone:772-288-6466
Mailing Address - Fax:772-288-6475
Practice Address - Street 1:310 SW OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2007
Practice Address - Country:US
Practice Address - Phone:772-288-6466
Practice Address - Fax:772-288-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care