MEDICARE: FLORIDA MEDICAL CLINIC, 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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1891463808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL CLINIC, LLC

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	352-567-0188
Fax Number	:	813-355-5101

Provider Business Practice Location Address
First Line	:	8146 CEREBELLUM WAY STE 101
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1786
Country	:	US
Telephone Number	:	727-375-8580
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOE DELATORRE
Credential	:
Telephone Number	:	813-780-8440

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	09/03/2021

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