Provider Demographics
NPI:1881063543
Name:HEALTHVENTURES LLC
Entity type:Organization
Organization Name:HEALTHVENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:NIMBARGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-782-3702
Mailing Address - Street 1:PO BOX 150038
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32715-0038
Mailing Address - Country:US
Mailing Address - Phone:407-782-3702
Mailing Address - Fax:
Practice Address - Street 1:321 MAITLAND AVENUE
Practice Address - Street 2:SUITE #1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-331-6236
Practice Address - Fax:386-218-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207Q00000X
FLPA9108843261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122346600Medicaid