# HEALTHVINE MEDICAL GROUP INC

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

## Provider details

- **NPI number:** 1568826873
- **Authorized official:** DR. MARIA D DOHERTY M.D (PRESIDENT)
- **Authorized official phone:** (352) 569-9990

## Contact information

- **Practice address:** 725 BENTON AVE, BROOKSVILLE, FL 34601-3213
- **Practice address phone:** (352) 796-1492
- **Mailing address:** 725 BENTON AVE, BROOKSVILLE, FL 34601-3213
- **Mailing address phone:** (352) 796-1492

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | FL | Yes |

## Other

- **Enumeration date:** 04/12/2016
- **Last updated:** 04/12/2016