MEDICARE: P.V.C. MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HCC6469	FL

General Provider Information

NPI Number	:	1093917767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.V.C. MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	3260 W HILLSBOROUGH AVE
Second Line	:	# 111
City	:	TAMPA
State	:	FL
Zip	:	33614-5902
Country	:	US
Telephone Number	:	813-873-9369
Fax Number	:	813-873-9386

Provider Business Practice Location Address
First Line	:	3260 W HILLSBOROUGH AVE
Second Line	:	# 111
City	:	TAMPA
State	:	FL
Zip	:	33614-5902
Country	:	US
Telephone Number	:	813-873-9369
Fax Number	:	813-873-9386

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSE ANTONIO PLASENCIA
Credential	:
Telephone Number	:	813-873-9369

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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