Healthcare Provider Details

I. General information

NPI: 1366866089
Provider Name (Legal Business Name): ALLEVENET QCN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 PROFESSIONAL PKWY E LAKEWOOD CORPORATE CENTER A
LAKEWOOD RANCH FL
34240-8414
US

IV. Provider business mailing address

6920 PROFESSIONAL PKWY E LAKEWOOD CORPORATE CENTER A
LAKEWOOD RANCH FL
34240-8414
US

V. Phone/Fax

Practice location:
  • Phone: 941-313-3300
  • Fax: 941-313-3405
Mailing address:
  • Phone: 941-313-3300
  • Fax: 941-313-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW I IMES
Title or Position: PRESIDENT
Credential:
Phone: 985-687-5636