Provider Demographics
NPI:1548345234
Name:MAVERICK MEDICAL VENTURES, INC.
Entity type:Organization
Organization Name:MAVERICK MEDICAL VENTURES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-342-7667
Mailing Address - Street 1:3501 CATTLEMEN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6055
Mailing Address - Country:US
Mailing Address - Phone:941-342-7667
Mailing Address - Fax:941-342-7847
Practice Address - Street 1:3501 CATTLEMEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6055
Practice Address - Country:US
Practice Address - Phone:941-342-7667
Practice Address - Fax:941-342-7847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5056261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7180294OtherAETNA PROVIDER NUMBER
FL2013853OtherFIRST HEALTH PROVIDER NUM
FL201694OtherSTAYWELL PROVIDER
FL226521OtherAMERIGROUP PROVIDER NUMBE
FLV2973OtherBCBS PROVIDER NUMBER
FL5425850OtherCCN PROVIDER NUMBER
FL82030OtherMEDICARE COMPLETE
FLA2545060OtherOXFORD PROVIDER
FL2013853OtherFIRST HEALTH PROVIDER NUM
FL=========OtherHUMANA PROVIDER NUM
FL=========OtherUNIVERSAL PROVIDER
FLV2973OtherBCBS PROVIDER NUMBER
FLA2545060OtherOXFORD PROVIDER
FLE4563Medicare ID - Type UnspecifiedPROVIDER NUMBER