Provider Demographics
NPI:1053190991
Name:ADVANCED WELLNESS INFUSION CENTERS, LLC
Entity type:Organization
Organization Name:ADVANCED WELLNESS INFUSION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:ALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-702-0850
Mailing Address - Street 1:616 N PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4417
Mailing Address - Country:US
Mailing Address - Phone:352-702-0850
Mailing Address - Fax:352-530-2476
Practice Address - Street 1:202 SW 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8138
Practice Address - Country:US
Practice Address - Phone:352-353-0055
Practice Address - Fax:352-443-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407893571OtherINDIVIDUAL NPI
FL1932199197OtherINDIVIDUAL NPI