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General NPI Number Information
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NPI Number | 1548836927
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Entity Type | Organization
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Legal Business Name | GRACE COMMUNITY MEDICAL CENTER
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 3222 N 34TH ST
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City | TAMPA
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State | FL
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Zip | 33605-2227
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Country | US
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Telephone | 813-930-5642
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Fax | 813-374-4979
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Provider Business Mailing Address
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Address Line | PO BOX 270114
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City | TAMPA
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State | FL
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Zip | 33688-0114
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Country | US
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Telephone | 813-930-5642
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GRACE GLENN
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Credential |
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Telephone | 813-930-5642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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