Provider Demographics
NPI:1619471158
Name:ESSENTIAL MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLAVENTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-620-5588
Mailing Address - Street 1:304 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0803
Mailing Address - Country:US
Mailing Address - Phone:352-507-2000
Mailing Address - Fax:352-633-4544
Practice Address - Street 1:304 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0803
Practice Address - Country:US
Practice Address - Phone:352-507-2000
Practice Address - Fax:352-633-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty