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General NPI Number Information
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NPI Number | 1417367574
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Entity Type | Organization
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Legal Business Name | ANCILLARY MD CORP
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 10948 N 56TH ST STE 202
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3001
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Country | US
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Telephone | 813-985-8513
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Fax | 813-436-5523
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Provider Business Mailing Address
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Address Line | 10948 N 56TH ST STE 202
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3001
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Country | US
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Telephone | 813-985-8513
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Fax | 813-436-5523
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Authorized Official
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Title or Position | OWNER
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Name | KURT SCHROEDER
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Credential |
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Telephone | 813-985-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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