Organization
ALLEVENET QCN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW I IMES (PRESIDENT)
(985) 687-5636
Entity
Organization
Contact information
Practice address
6920 PROFESSIONAL PKWY E, LAKEWOOD CORPORATE CENTER A, LAKEWOOD RANCH, FL 34240-8414
(941) 313-3300
(941) 313-3405
Mailing address
6920 PROFESSIONAL PKWY E, LAKEWOOD CORPORATE CENTER A, LAKEWOOD RANCH, FL 34240-8414
(941) 313-3300
(941) 313-3405
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
02/17/2014
Last updated
02/17/2014
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