Provider Demographics
NPI:1457672180
Name:CTM HEALTHCARE LLC
Entity Type:Organization
Organization Name:CTM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-200-7717
Mailing Address - Street 1:5503 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5419
Mailing Address - Country:US
Mailing Address - Phone:813-200-7717
Mailing Address - Fax:813-985-8500
Practice Address - Street 1:5503 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5419
Practice Address - Country:US
Practice Address - Phone:813-200-7717
Practice Address - Fax:813-985-8500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERSTRIDE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-16
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty