Provider Demographics
NPI:1376848887
Name:CENTER FOR INTERNAL MEDICINE INC TEMPLE TERRACE
Entity Type:Organization
Organization Name:CENTER FOR INTERNAL MEDICINE INC TEMPLE TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-985-2333
Mailing Address - Street 1:4941 EAST BUSCH BLVD,
Mailing Address - Street 2:SUITE #140, TEMPLE TERRACE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-985-2333
Mailing Address - Fax:813-989-8746
Practice Address - Street 1:4941 E BUSCH BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-6056
Practice Address - Country:US
Practice Address - Phone:813-985-2333
Practice Address - Fax:813-989-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty