Provider Demographics
NPI:1346788783
Name:GOD'S SPEED MEDICAL CENTER
Entity Type:Organization
Organization Name:GOD'S SPEED MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-769-9342
Mailing Address - Street 1:11641 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5531
Mailing Address - Country:US
Mailing Address - Phone:813-769-9342
Mailing Address - Fax:813-769-9457
Practice Address - Street 1:11641 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5531
Practice Address - Country:US
Practice Address - Phone:813-769-9342
Practice Address - Fax:813-769-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care