MEDICARE: CENTRIC MEDICAL CENTERS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1174457956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRIC MEDICAL CENTERS, INC.

Provider Business Mailing Address
First Line	:	3836 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1955
Country	:	US
Telephone Number	:	813-931-1682
Fax Number	:	813-931-1683

Provider Business Practice Location Address
First Line	:	3836 W HUMPHREY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1955
Country	:	US
Telephone Number	:	813-931-1682
Fax Number	:	813-931-1683

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS LOPEZ
Credential	:
Telephone Number	:	813-931-1682

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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