Healthcare Provider Details

I. General information

NPI: 1669063475
Provider Name (Legal Business Name): MEDWAY MEDICAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 GRAND BLVD
NEW PORT RICHEY FL
34652-5106
US

IV. Provider business mailing address

4802 GRAND BLVD
NEW PORT RICHEY FL
34652-5106
US

V. Phone/Fax

Practice location:
  • Phone: 727-877-8837
  • Fax:
Mailing address:
  • Phone: 727-877-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO ACOSTA
Title or Position: OWNER
Credential:
Phone: 786-277-6701