Healthcare Provider Details

I. General information

NPI: 1174223416
Provider Name (Legal Business Name): AMA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 MISSOURI AVE N
LARGO FL
33770-1849
US

IV. Provider business mailing address

1280 MISSOURI AVE N
LARGO FL
33770-1849
US

V. Phone/Fax

Practice location:
  • Phone: 952-653-2525
  • Fax: 952-653-2540
Mailing address:
  • Phone: 952-653-2525
  • Fax: 952-653-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO SOUCHET
Title or Position: PRACTICE MANAGER
Credential:
Phone: 727-331-8740