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General NPI Number Information
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NPI Number | 1528674447
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Entity Type | Organization
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Legal Business Name | MIDTOWN COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 4728 N HABANA AVE # 100A
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City | TAMPA
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State | FL
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Zip | 33614-7100
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Country | US
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Telephone | 813-536-7291
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Fax | 813-536-7293
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Provider Business Mailing Address
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Address Line | 4728 N HABANA AVE # 100A
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City | TAMPA
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State | FL
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Zip | 33614-7100
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Country | US
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Telephone | 813-536-7291
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Fax | 813-536-7293
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Authorized Official
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Title or Position | OWNER
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Name | WALE JULIUS
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Credential |
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Telephone | 813-536-7291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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