Provider Demographics
NPI:1972145530
Name:ATHENA HEALTHCARE INC.
Entity Type:Organization
Organization Name:ATHENA HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RUELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-593-2814
Mailing Address - Street 1:524 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4531
Mailing Address - Country:US
Mailing Address - Phone:407-593-2814
Mailing Address - Fax:407-593-2815
Practice Address - Street 1:524 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4531
Practice Address - Country:US
Practice Address - Phone:407-593-2814
Practice Address - Fax:407-593-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty