Provider Demographics
NPI:1366866089
Name:ALLEVENET QCN
Entity Type:Organization
Organization Name:ALLEVENET QCN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:I
Authorized Official - Last Name:IMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-687-5636
Mailing Address - Street 1:6920 PROFESSIONAL PKWY E
Mailing Address - Street 2:LAKEWOOD CORPORATE CENTER A
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8414
Mailing Address - Country:US
Mailing Address - Phone:941-313-3300
Mailing Address - Fax:941-313-3405
Practice Address - Street 1:6920 PROFESSIONAL PKWY E
Practice Address - Street 2:LAKEWOOD CORPORATE CENTER A
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8414
Practice Address - Country:US
Practice Address - Phone:941-313-3300
Practice Address - Fax:941-313-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization