Provider Demographics
NPI:1114397809
Name:APOLLO HEALTHCARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:APOLLO HEALTHCARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OJHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-506-3985
Mailing Address - Street 1:1326 MALABAR RD SE STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2502
Mailing Address - Country:US
Mailing Address - Phone:321-409-6100
Mailing Address - Fax:321-409-6063
Practice Address - Street 1:1326 MALABAR RD SE STE 3
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2502
Practice Address - Country:US
Practice Address - Phone:321-409-6100
Practice Address - Fax:321-409-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263030300Medicaid
FL05080YMedicare PIN
FLH51853Medicare UPIN