Organization
MAR PRIMARY CARE LLC
Active
Other names
Citrus Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MEAGAN CHRISTINE MANE (CFO)
(813) 935-4744
Entity
Organization
Contact information
Practice address
2901 W SAINT ISABEL ST STE F, TAMPA, FL 33607-6371
(813) 935-4744
Mailing address
2901 W SAINT ISABEL ST STE F, TAMPA, FL 33607-6371
(813) 935-4744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103843600
—
FL
01
—
435I
AVMED
FL
01
—
6986186
AETNA
FL
01
—
7420970
CIGNA
FL
01
—
JI8GZ
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/18/2018
Last updated
11/23/2020
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