Healthcare Provider Details

I. General information

NPI: 1548969280
Provider Name (Legal Business Name): UNITED METABOLIC TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH PINELLAS AVE. SUITE 1
TARPON SPRINGS FL
34689
US

IV. Provider business mailing address

808 LANSDEN COURT
TARPON SPRINGS FL
34689
US

V. Phone/Fax

Practice location:
  • Phone: 727-682-5917
  • Fax: 727-334-2244
Mailing address:
  • Phone: 727-424-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM R OLIVE, JR
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-424-3830