Provider Demographics
NPI:1275212318
Name:MOMENTUM HEALTH CENTERS OF FLORIDA
Entity Type:Organization
Organization Name:MOMENTUM HEALTH CENTERS OF FLORIDA
Other - Org Name:CHAMPION COMPREHENSIVE HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-445-6550
Mailing Address - Street 1:4211 W BOY SCOUT BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5724
Mailing Address - Country:US
Mailing Address - Phone:813-445-6550
Mailing Address - Fax:813-445-6505
Practice Address - Street 1:4211 W BOY SCOUT BLVD STE 450
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5724
Practice Address - Country:US
Practice Address - Phone:813-445-6550
Practice Address - Fax:813-445-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty