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General NPI Number Information
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NPI Number | 1275067555
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Entity Type | Organization
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Legal Business Name | AENDIRA MEDICAL LLC
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1675 HANCOCK RD SUITE 300
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-978-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 HANCOCK RD SUITE 300
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City | CLERMONT
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State | FL
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Zip | 34711-7667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ADRIANNE FERGUSON
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Credential |
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Telephone | 352-432-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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