Provider Demographics
NPI:1477204139
Name:HUMANA MEDICAL PLAN INC
Entity Type:Organization
Organization Name:HUMANA MEDICAL PLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-226-7199
Mailing Address - Street 1:3111 W DR MARTIN LUTHER KING JR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3111 W DR MARTIN LUTHER KING JR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6225
Practice Address - Country:US
Practice Address - Phone:813-226-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100049903Medicaid