Provider Demographics
NPI:1295032209
Name:PR MEDICAL CENTER PLC
Entity Type:Organization
Organization Name:PR MEDICAL CENTER PLC
Other - Org Name:PR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELSHAFEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH-ASHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-988-1500
Mailing Address - Street 1:10750 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3615
Mailing Address - Country:US
Mailing Address - Phone:813-988-1500
Mailing Address - Fax:
Practice Address - Street 1:10750 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3615
Practice Address - Country:US
Practice Address - Phone:813-988-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC207208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty