Healthcare Provider Details

I. General information

NPI: 1780062919
Provider Name (Legal Business Name): MEMORIAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 N DALE MABRY HWY STE 501
TAMPA FL
33614-3265
US

IV. Provider business mailing address

8001 N DALE MABRY HWY STE 501
TAMPA FL
33614-3265
US

V. Phone/Fax

Practice location:
  • Phone: 813-605-4725
  • Fax: 813-605-4726
Mailing address:
  • Phone: 813-605-4725
  • Fax: 813-605-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCC 10337
License Number StateFL

VIII. Authorized Official

Name: MS. MAVYS HUICE
Title or Position: OWNER
Credential:
Phone: 813-605-4725