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General NPI Number Information
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NPI Number | 1093917767
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Entity Type | Organization
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Legal Business Name | P.V.C. MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3260 W HILLSBOROUGH AVE # 111
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City | TAMPA
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State | FL
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Zip | 33614-5902
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Country | US
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Telephone | 813-873-9369
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Fax | 813-873-9386
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Provider Business Mailing Address
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Address Line | 3260 W HILLSBOROUGH AVE # 111
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City | TAMPA
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State | FL
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Zip | 33614-5902
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Country | US
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Telephone | 813-873-9369
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Fax | 813-873-9386
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE ANTONIO PLASENCIA
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Credential |
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Telephone | 813-873-9369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC6469
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License Number State | FL
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