Healthcare Provider Details

I. General information

NPI: 1245532886
Provider Name (Legal Business Name): HRC MEDICAL - TAMPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N WESTSHORE BLVD SUITE 100
TAMPA FL
33607-3925
US

IV. Provider business mailing address

1715 N WESTSHORE BLVD SUITE 100
TAMPA FL
33607-3925
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-2929
  • Fax: 813-402-2956
Mailing address:
  • Phone: 813-871-2929
  • Fax: 813-402-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number60 3513
License Number StateFL

VIII. Authorized Official

Name: MICHAEL MONTEMURRO
Title or Position: PRESIDENT
Credential:
Phone: 813-871-2929