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NPI Code Detail

MEDICARE: MEDERI CARETENDERS VS OF TAMPA, LLC

MEDICARE: MEDERI CARETENDERS VS OF TAMPA, 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1366631061
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDERI CARETENDERS VS OF TAMPA, LLC
Provider Business Mailing Address
First Line : 901 HUGH WALLIS RD S
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-2511
Country : US
Telephone Number : 337-233-1307
Fax Number : 337-443-4154
Provider Business Practice Location Address
First Line : 1413 TECH BLVD STE 125
Second Line :
City : TAMPA
State : FL
Zip : 33619-7822
Country : US
Telephone Number : 813-282-8520
Fax Number : 813-282-8530
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOSHUA L PROFFITT
Credential :
Telephone Number : 337-233-1307
Provider Enumeration Date : 10/18/2007
Last Update Date : 09/16/2024

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Directions to “MEDERI CARETENDERS VS OF TAMPA, LLC ” Practice Location

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