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General NPI Number Information
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NPI Number | 1104441617
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Entity Type | Organization
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Legal Business Name | PROMEDTC, LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 3109 LITHIA PINECREST RD
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City | VALRICO
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State | FL
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Zip | 33596-5632
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Country | US
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Telephone | 718-666-8759
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N ASHLEY DR UNIT 1815
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City | TAMPA
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State | FL
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Zip | 33602-4373
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Country | US
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Telephone | 718-666-8759
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TYMUR CHEPI-IPA
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Credential | APRN-C
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Telephone | 718-666-8759
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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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