MEDICARE: YBOR MEDICAL INJURY AND ACCIDENT CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	5231	FL

General Provider Information

NPI Number	:	1275048845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YBOR MEDICAL INJURY AND ACCIDENT CLINIC INC

Provider Business Mailing Address
First Line	:	3119 E 7TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-4207
Country	:	US
Telephone Number	:	813-241-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	3119 E 7TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-4207
Country	:	US
Telephone Number	:	813-241-2335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANGELA IPPOLETO DUNCAN
Credential	:
Telephone Number	:	813-735-2229

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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