Provider Demographics
NPI:1427205970
Name:MORTON PLANT MEASE PRIMARY CARE INC
Entity Type:Organization
Organization Name:MORTON PLANT MEASE PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-281-9390
Mailing Address - Street 1:2995 DREW STREET
Mailing Address - Street 2:EAST BLDG 2ND FLOOR
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759
Mailing Address - Country:US
Mailing Address - Phone:727-281-9390
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:120 PINE AVE N
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4679
Practice Address - Country:US
Practice Address - Phone:813-814-9504
Practice Address - Fax:813-814-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORTON PLANT MEASE PRIMARY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5158060003Medicare NSC