Healthcare Provider Details

I. General information

NPI: 1194227652
Provider Name (Legal Business Name): FIRST HARBOUR MEDICAL CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 59TH ST W STE M
BRADENTON FL
34209-7021
US

IV. Provider business mailing address

7320 DELAINEY CT
LAKEWOOD RANCH FL
34240-8445
US

V. Phone/Fax

Practice location:
  • Phone: 941-795-7401
  • Fax:
Mailing address:
  • Phone: 941-373-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA WATTERS
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 941-243-4660