Provider Demographics
NPI:1164833984
Name:MPN MEDICAL CENTER CARROLLWOOD
Entity Type:Organization
Organization Name:MPN MEDICAL CENTER CARROLLWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-388-2945
Mailing Address - Street 1:2607 WINDGUARD CIR STE 101
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 1:7001 N DALE MABRY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-932-2848
Practice Address - Fax:813-932-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care