Provider Demographics
NPI:1417423344
Name:MAR PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MAR PRIMARY CARE LLC
Other - Org Name:CITRUS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-4744
Mailing Address - Street 1:2901 W SAINT ISABEL ST STE F
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6371
Mailing Address - Country:US
Mailing Address - Phone:813-935-4744
Mailing Address - Fax:
Practice Address - Street 1:2901 W SAINT ISABEL ST STE F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6371
Practice Address - Country:US
Practice Address - Phone:813-935-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJI8GZOtherBLUE CROSS BLUE SHIELD
FL435IOtherAVMED
FL103843600Medicaid
FL6986186OtherAETNA
FL7420970OtherCIGNA