Organization
MARINER PRIMECARE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN REVELLO MPH (PRESIDENT)
(813) 514-6750
Entity
Organization
Contact information
Practice address
7056 MARINER BLVD, SPRING HILL, FL 34609-1000
(352) 597-5557
(352) 597-0552
Mailing address
7056 MARINER BLVD, SPRING HILL, FL 34609-1000
(352) 597-5557
(352) 597-0552
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME83175
FL
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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