Provider Demographics
NPI:1629704176
Name:AMA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:AMA MEDICAL GROUP LLC
Other - Org Name:AMA MEDICAL GROUP OF LARGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:MARTINA
Authorized Official - Last Name:FANA-SOUCHET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-331-8740
Mailing Address - Street 1:125 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1280 MISSOURI AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1849
Practice Address - Country:US
Practice Address - Phone:727-331-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMA MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty