Provider Demographics
NPI:1841751161
Name:FREEDOM ANCILLARY HEALTH
Entity Type:Organization
Organization Name:FREEDOM ANCILLARY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:407-404-2342
Mailing Address - Street 1:15310 AMBERLY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1642
Mailing Address - Country:US
Mailing Address - Phone:407-988-7363
Mailing Address - Fax:407-624-4077
Practice Address - Street 1:15310 AMBERLY DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1642
Practice Address - Country:US
Practice Address - Phone:407-988-7363
Practice Address - Fax:407-624-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization