Provider Demographics
NPI:1770235376
Name:ALLEGIANT HEALTH & ASSOCIATES
Entity Type:Organization
Organization Name:ALLEGIANT HEALTH & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:863-528-8202
Mailing Address - Street 1:PO BOX 92923
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-2923
Mailing Address - Country:US
Mailing Address - Phone:863-528-8202
Mailing Address - Fax:
Practice Address - Street 1:1132 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3903
Practice Address - Country:US
Practice Address - Phone:863-256-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty