Healthcare Provider Details

I. General information

NPI: 1962054841
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF SEABROOK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 LAFAYETTE RD
SEABROOK NH
03874-4539
US

IV. Provider business mailing address

PO BOX 3523
SPRINGFIELD IL
62708-3523
US

V. Phone/Fax

Practice location:
  • Phone: 603-218-1793
  • Fax: 603-218-1794
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