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General NPI Number Information
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NPI Number | 1225641954
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Entity Type | Organization
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Legal Business Name | AVON PARK MEDICAL GROUP, LLC.
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1023 US HIGHWAY 27 S
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City | AVON PARK
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State | FL
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Zip | 33825-5107
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Country | US
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Telephone | 863-201-7329
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Fax | 863-201-7251
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Provider Business Mailing Address
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Address Line | 5901 WEBB RD
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City | TAMPA
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State | FL
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Zip | 33615-3219
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Country | US
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Telephone | 813-888-8215
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Fax | 813-885-5398
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Authorized Official
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Title or Position | CFO
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Name | ANTONIO CALVO
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Credential |
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Telephone | 813-888-8215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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