Provider Demographics
NPI:1083210215
Name:PLANT CITY PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:PLANT CITY PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PULCINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-269-6426
Mailing Address - Street 1:6101 WEBB RD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2865
Mailing Address - Country:US
Mailing Address - Phone:813-269-6426
Mailing Address - Fax:
Practice Address - Street 1:2507 THONOTOSASSA RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1464
Practice Address - Country:US
Practice Address - Phone:813-269-6426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty