Provider Demographics
NPI:1417367574
Name:ANCILLARY MD CORP
Entity Type:Organization
Organization Name:ANCILLARY MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-985-8533
Mailing Address - Street 1:10948 N 56TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3001
Mailing Address - Country:US
Mailing Address - Phone:813-985-8513
Mailing Address - Fax:813-436-5523
Practice Address - Street 1:10948 N 56TH ST STE 202
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3001
Practice Address - Country:US
Practice Address - Phone:813-985-8513
Practice Address - Fax:813-436-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site