Healthcare Provider Details

I. General information

NPI: 1346560216
Provider Name (Legal Business Name): MEDICOR HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 W WATERS AVE
TAMPA FL
33614-2713
US

IV. Provider business mailing address

PO BOX 415000
NASHVILLE TN
37241-5000
US

V. Phone/Fax

Practice location:
  • Phone: 813-930-8000
  • Fax: 813-930-6220
Mailing address:
  • Phone: 800-250-4468
  • Fax: 866-930-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MANUEL DELGADO JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-930-8000