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General NPI Number Information
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NPI Number | 1033534615
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Entity Type | Organization
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Legal Business Name | MPN MEDICAL CENTER PORT RICHEY
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 6610 EMBASSY BLVD
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City | PORT RICHEY
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State | FL
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Zip | 34668-4897
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Country | US
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Telephone | 727-848-2233
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Fax | 727-847-4945
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Provider Business Mailing Address
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Address Line | 2607 WINDGUARD CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7352
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Country | US
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Telephone | 813-388-2945
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Fax | 813-333-0606
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Authorized Official
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Title or Position | CEO
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Name | HERBERT MINOR
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Credential |
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Telephone | 813-388-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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