Healthcare Provider Details

I. General information

NPI: 1043580111
Provider Name (Legal Business Name): B & T MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 N HABANA AVE SUITE 1
TAMPA FL
33614-6890
US

IV. Provider business mailing address

988 E OSCEOLA PKWY
KISSIMMEE FL
34744-1615
US

V. Phone/Fax

Practice location:
  • Phone: 813-644-6991
  • Fax:
Mailing address:
  • Phone: 407-944-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: VIVIANA SANTANA
Title or Position: BILLING COORDINATOR
Credential:
Phone: 813-644-6991