Provider Demographics
NPI:1609655323
Name:ZIVA MEDICAL AUDRAIN LLC
Entity Type:Organization
Organization Name:ZIVA MEDICAL AUDRAIN LLC
Other - Org Name:ZIVAMED PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-570-3555
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-0197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 E PROMENADE ST # A
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2966
Practice Address - Country:US
Practice Address - Phone:573-570-3520
Practice Address - Fax:573-675-6040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZIVA MEDICAL AUDRAIN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-22
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty