Provider Demographics
NPI:1275108854
Name:PRIME ENDOCRINOLOGY OF TAMPA, LLC
Entity Type:Organization
Organization Name:PRIME ENDOCRINOLOGY OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-499-0356
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-499-0356
Mailing Address - Fax:727-781-3312
Practice Address - Street 1:8837 CITRUS PALM DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4735
Practice Address - Country:US
Practice Address - Phone:727-499-0356
Practice Address - Fax:727-781-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME134258OtherLICENSE