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General NPI Number Information
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NPI Number | 1790457836
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Entity Type | Organization
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Legal Business Name | INDEPENDENT MEDICAL GROUP, LLC.
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 14902 WINDING CREEK CT STE 105C
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City | TAMPA
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State | FL
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Zip | 33613-1640
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Country | US
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Telephone | 407-314-7492
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 NW 88TH AVE STE 390
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City | TAMARAC
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State | FL
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Zip | 33321-4451
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Country | US
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Telephone | 407-860-0283
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS MANAGER
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Name | SONIA N TORRES
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Credential |
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Telephone | 407-860-0283
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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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