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General NPI Number Information
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NPI Number | 1730626656
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Entity Type | Organization
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Legal Business Name | PLANT CITY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 2021 N WHEELER ST STE 100
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City | PLANT CITY
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State | FL
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Zip | 33563-1860
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Country | US
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Telephone | 561-866-8186
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 N WHEELER ST STE 100
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City | PLANT CITY
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State | FL
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Zip | 33563-1860
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Country | US
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Telephone | 561-866-8186
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISTOPHER KIRBY
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Credential | M.D.
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Telephone | 813-756-5666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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