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General NPI Number Information
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NPI Number | 1376805168
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Entity Type | Organization
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Legal Business Name | NOORANI MEDICAL CENTER LLC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 10924 BLOOMINGDALE AVE
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City | RIVERVIEW
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State | FL
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Zip | 33578-3633
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Country | US
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Telephone | 813-571-1111
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Fax | 813-571-1120
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Provider Business Mailing Address
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Address Line | 10924 BLOOMINGDALE AVE
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City | RIVERVIEW
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State | FL
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Zip | 33578-3633
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Country | US
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Telephone | 813-571-1111
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Fax | 813-571-1120
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SARAH PRIMM
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Credential |
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Telephone | 813-571-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 36113183
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License Number State | FL
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