Provider Demographics
NPI:1295752053
Name:ASSOCIATE MEDICAL MANAGEMENT, INC
Entity type:Organization
Organization Name:ASSOCIATE MEDICAL MANAGEMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:321-327-5910
Mailing Address - Street 1:2105 PALM BAY RD NE
Mailing Address - Street 2:SUITE 1-W
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2937
Mailing Address - Country:US
Mailing Address - Phone:321-327-5910
Mailing Address - Fax:321-327-5912
Practice Address - Street 1:2105 PALM BAY RD NE
Practice Address - Street 2:SUITE 1-W
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2937
Practice Address - Country:US
Practice Address - Phone:321-327-5910
Practice Address - Fax:321-327-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care