Provider Demographics
NPI:1639458821
Name:AVAHEALTH, INC.
Entity Type:Organization
Organization Name:AVAHEALTH, INC.
Other - Org Name:KEY INSURANCE PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-868-5959
Mailing Address - Street 1:5440 MARINER ST
Mailing Address - Street 2:SUITE 110, BUILDING 9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3446
Mailing Address - Country:US
Mailing Address - Phone:813-868-5959
Mailing Address - Fax:813-288-8520
Practice Address - Street 1:5440 MARINER ST
Practice Address - Street 2:SUITE 110, BUILDING 9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3446
Practice Address - Country:US
Practice Address - Phone:813-868-5959
Practice Address - Fax:813-288-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11-305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization