Provider Demographics
NPI:1093883985
Name:TOWN N COUNTRY MEDICAL
Entity Type:Organization
Organization Name:TOWN N COUNTRY MEDICAL
Other - Org Name:TOWN N COUNTRY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-968-3377
Mailing Address - Street 1:7926 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4600
Mailing Address - Country:US
Mailing Address - Phone:813-968-3377
Mailing Address - Fax:813-968-1028
Practice Address - Street 1:7926 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4600
Practice Address - Country:US
Practice Address - Phone:813-885-6538
Practice Address - Fax:813-885-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMS0001484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty