Provider Demographics
NPI:1275048845
Name:YBOR MEDICAL INJURY AND ACCIDENT CLINIC INC
Entity Type:Organization
Organization Name:YBOR MEDICAL INJURY AND ACCIDENT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:IPPOLETO
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-735-2229
Mailing Address - Street 1:3119 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-4207
Mailing Address - Country:US
Mailing Address - Phone:813-241-2335
Mailing Address - Fax:
Practice Address - Street 1:3119 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-4207
Practice Address - Country:US
Practice Address - Phone:813-241-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5231261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center