MEDICARE: TOWN N COUNTRY MEDICAL CARE LLC

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356926240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN N COUNTRY MEDICAL CARE LLC

Provider Business Mailing Address
First Line	:	6107 MEMORIAL HWY STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4564
Country	:	US
Telephone Number	:	813-514-2328
Fax Number	:	813-514-2485

Provider Business Practice Location Address
First Line	:	6107 MEMORIAL HWY STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4564
Country	:	US
Telephone Number	:	813-514-2328
Fax Number	:	813-514-2485

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHITAL MEHTA
Credential	:	DO
Telephone Number	:	813-486-6442

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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