Provider Demographics
NPI:1578384996
Name:DOVE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:DOVE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:720-737-1668
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:LOUGHMAN
Mailing Address - State:FL
Mailing Address - Zip Code:33858-0626
Mailing Address - Country:US
Mailing Address - Phone:720-737-1668
Mailing Address - Fax:
Practice Address - Street 1:35600 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3731
Practice Address - Country:US
Practice Address - Phone:863-420-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332900000XSuppliersNon-Pharmacy Dispensing Site