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General NPI Number Information
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NPI Number | 1407176506
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Entity Type | Organization
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Legal Business Name | PADGETT MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 18952 DALE MABRY HWY N STE 101
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City | LUTZ
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State | FL
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Zip | 33548-4916
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Country | US
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Telephone | 813-949-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 W LE COMPTE DR
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City | TAMPA
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State | FL
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Zip | 33604-5827
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Country | US
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Telephone | 813-943-3353
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Fax | 813-907-0027
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Authorized Official
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Title or Position | OWNER
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Name | SHAUN PADGETT
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Credential | LMT
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Telephone | 813-907-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | PMC 959
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License Number State | FL
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