MEDICARE: PREFERRED INJURY PHYSICIANS OF TOWN & COUNTRY 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	261Q00000X	Clinic/Center	CH10487	FL

General Provider Information

NPI Number	:	1568914935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED INJURY PHYSICIANS OF TOWN & COUNTRY INC

Provider Business Mailing Address
First Line	:	5411 BEAUMONT CENTER BLVD
Second Line	:	SUITE 785
City	:	TAMPA
State	:	FL
Zip	:	33634-5260
Country	:	US
Telephone Number	:	407-900-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	5411 BEAUMONT CENTER BLVD
Second Line	:	SUITE 785
City	:	TAMPA
State	:	FL
Zip	:	33634-5260
Country	:	US
Telephone Number	:	407-900-7246
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	MARIJO ST-LAURENT
Credential	:
Telephone Number	:	386-317-9067

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	04/25/2019

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