Provider Demographics
NPI:1710562764
Name:NAPLES DIRECT MEDICAL PLLC
Entity type:Organization
Organization Name:NAPLES DIRECT MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-978-8754
Mailing Address - Street 1:1755 HERITAGE TRL STE 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-7600
Mailing Address - Country:US
Mailing Address - Phone:239-529-2581
Mailing Address - Fax:239-331-8287
Practice Address - Street 1:1755 HERITAGE TRL STE 601
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-7600
Practice Address - Country:US
Practice Address - Phone:239-529-2581
Practice Address - Fax:239-331-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care