Provider Demographics
NPI:1033534615
Name:MPN MEDICAL CENTER PORT RICHEY
Entity Type:Organization
Organization Name:MPN MEDICAL CENTER PORT RICHEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-388-2945
Mailing Address - Street 1:2607 WINDGUARD CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7352
Mailing Address - Country:US
Mailing Address - Phone:813-388-2945
Mailing Address - Fax:813-333-0606
Practice Address - Street 1:6610 EMBASSY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4897
Practice Address - Country:US
Practice Address - Phone:727-848-2233
Practice Address - Fax:727-847-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care