Provider Demographics
NPI:1003392390
Name:VERIMED HEALTH GROUP BRANDON, LLC
Entity Type:Organization
Organization Name:VERIMED HEALTH GROUP BRANDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-324-9463
Mailing Address - Street 1:500 VONDERBURG DR STE 310
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5978
Mailing Address - Country:US
Mailing Address - Phone:813-324-9463
Mailing Address - Fax:813-502-6385
Practice Address - Street 1:500 VONDERBURG DR STE 310
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5978
Practice Address - Country:US
Practice Address - Phone:813-324-9463
Practice Address - Fax:813-502-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center