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General NPI Number Information
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NPI Number | 1508012477
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Entity Type | Organization
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Legal Business Name | TOMMY L LOUISVILLE MD PA
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 1598 US 27 N
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City | AVON PARK
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State | FL
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Zip | 33825-2151
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Country | US
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Telephone | 863-452-1980
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Fax | 407-386-3342
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Provider Business Mailing Address
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Address Line | 1598 US 27 N
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City | AVON PARK
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State | FL
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Zip | 33825-2151
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Country | US
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Telephone | 863-452-1980
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Fax | 407-386-3342
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Authorized Official
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Title or Position | CEO
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Name | TOMMY L LOUISVILLE
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Credential | MD
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Telephone | 863-452-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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