MEDICARE: A&G 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1407809965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&G MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	4311 W WATERS AVE
Second Line	:	SUITE 590
City	:	TAMPA
State	:	FL
Zip	:	33614-1901
Country	:	US
Telephone Number	:	813-249-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 W WATERS AVE
Second Line	:	SUITE 590
City	:	TAMPA
State	:	FL
Zip	:	33614-1901
Country	:	US
Telephone Number	:	813-249-9262
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IBIS GOMEZ
Credential	:
Telephone Number	:	813-249-9262

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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Directions to “A&G MEDICAL CENTER INC ” Practice Location

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