Provider Demographics
NPI:1407176506
Name:PADGETT MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PADGETT MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-907-2011
Mailing Address - Street 1:1503 W LE COMPTE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5827
Mailing Address - Country:US
Mailing Address - Phone:813-943-3353
Mailing Address - Fax:813-907-0027
Practice Address - Street 1:18952 DALE MABRY HWY N STE 101
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4916
Practice Address - Country:US
Practice Address - Phone:813-949-7105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC 959208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty