MEDICARE: CENTER FOR INTERNAL MEDICINE INC TEMPLE TERRACE

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	207R00000X	Internal Medicine Physician	ME54314	FL

General Provider Information

NPI Number	:	1376848887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INTERNAL MEDICINE INC TEMPLE TERRACE

Provider Business Mailing Address
First Line	:	4941 EAST BUSCH BLVD,
Second Line	:	SUITE #140, TEMPLE TERRACE
City	:	TAMPA
State	:	FL
Zip	:	33617
Country	:	US
Telephone Number	:	813-985-2333
Fax Number	:	813-989-8746

Provider Business Practice Location Address
First Line	:	4941 E BUSCH BLVD
Second Line	:	SUITE #140
City	:	TAMPA
State	:	FL
Zip	:	33617-6056
Country	:	US
Telephone Number	:	813-985-2333
Fax Number	:	813-989-8746

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. IVETTE HERNANDEZ
Credential	:	M.D
Telephone Number	:	813-985-2333

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	09/21/2011

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