Provider Demographics
NPI:1407809965
Name:A&G MEDICAL CENTER INC
Entity Type:Organization
Organization Name:A&G MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IBIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-249-9262
Mailing Address - Street 1:4311 W WATERS AVE
Mailing Address - Street 2:SUITE 590
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1901
Mailing Address - Country:US
Mailing Address - Phone:813-249-9262
Mailing Address - Fax:
Practice Address - Street 1:4311 W WATERS AVE
Practice Address - Street 2:SUITE 590
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1901
Practice Address - Country:US
Practice Address - Phone:813-249-9262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty