MEDICARE: FLORIDA MEDICAL CLINIC, 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	291U00000X	Clinical Medical Laboratory	800006196	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690006221	OTHER	FL	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1568425809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL CLINIC, LLC

Provider Business Mailing Address
First Line	:	38135 MARKET SQUARE
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542
Country	:	US
Telephone Number	:	813-780-1255
Fax Number	:	813-780-9773

Provider Business Practice Location Address
First Line	:	17401 COMMERCE PARK BLVD STE 107
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3507
Country	:	US
Telephone Number	:	813-782-8311
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOE I DELATORRE
Credential	:
Telephone Number	:	813-780-8440

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	02/21/2020

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