Healthcare Provider Details

I. General information

NPI: 1023780657
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF PORTSMOUTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SHATTUCK WAY
NEWINGTON NH
03801-7869
US

IV. Provider business mailing address

PO BOX 20848
SPRINGFIELD IL
62708-0848
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-3381
  • Fax: 561-330-3382
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN VAN SPRUNDEL
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 941-725-1198