SANTURCE MEDICAL CENTER LLC NPI 1649725029

NPI Information

NPI: 1649725029
Provider Name: SANTURCE MEDICAL CENTER LLC
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 10D2121793

Address:
500 VONDERBURG DR STE 305
BRANDON, FL
ZIP 33511
Phone: (813) 651-0005
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SANTURCE MEDICAL CENTER LLC is a general practice in Brandon, FL. SANTURCE MEDICAL CENTER LLC NPI is 1649725029. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

500 VONDERBURG DR STE 305
BRANDON, FL
ZIP 33511-976
Phone: (813) 651-0005
Fax: (813) 902-7234

The provider's authorized official is Orlando E Mieles .
The authorized official title is Md/ceo and has the following contact phone number (813) 651-0005.

The CLIA number assigned to this NPI record is 10D2121793 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2016 and was last updated on 7/31/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1700149143	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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