# MARINER PRIMECARE MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316192867
- **Authorized official:** MR. MARTIN REVELLO MPH (PRESIDENT)
- **Authorized official phone:** (813) 514-6750

## Contact information

- **Practice address:** 7056 MARINER BLVD, SPRING HILL, FL 34609-1000
- **Practice address phone:** (352) 597-5557
- **Practice address fax:** (352) 597-0552
- **Mailing address:** 7056 MARINER BLVD, SPRING HILL, FL 34609-1000
- **Mailing address phone:** (352) 597-5557
- **Mailing address fax:** (352) 597-0552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME83175 | FL | Yes |

## Other

- **Enumeration date:** 11/25/2008
- **Last updated:** 11/25/2008