Healthcare Provider Details

I. General information

NPI: 1821597444
Provider Name (Legal Business Name): PCHP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 W CYPRESS ST STE G
TAMPA FL
33607-1777
US

IV. Provider business mailing address

PO BOX 20547
TAMPA FL
33622-0547
US

V. Phone/Fax

Practice location:
  • Phone: 317-245-7482
  • Fax:
Mailing address:
  • Phone: 813-812-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ELAINE RAWLINGS
Title or Position: CEO
Credential:
Phone: 813-812-4161