MEDICARE: PCC PRIMARY CARE LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1285455154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PCC PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	3258 PARKSIDE CENTER CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0907
Country	:	US
Telephone Number	:	813-995-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3258 PARKSIDE CENTER CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0907
Country	:	US
Telephone Number	:	813-995-7192
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	ALDO MADRIGAL
Credential	:
Telephone Number	:	813-995-7192

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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