MEDICARE: FAMILY HEALTH 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1417591710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	2801 W WATERS AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1866
Country	:	US
Telephone Number	:	813-304-1001
Fax Number	:	813-304-1024

Provider Business Practice Location Address
First Line	:	2801 W WATERS AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1866
Country	:	US
Telephone Number	:	813-304-1001
Fax Number	:	813-304-1024

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE V PUJOLS
Credential	:
Telephone Number	:	813-802-2217

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	10/30/2019

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