Provider Demographics
NPI:1477835221
Name:P V C MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:P V C MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-901-9369
Mailing Address - Street 1:5011 W HILLSBOROUGH AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5309
Mailing Address - Country:US
Mailing Address - Phone:813-901-9369
Mailing Address - Fax:813-901-9368
Practice Address - Street 1:5011 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE N
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5309
Practice Address - Country:US
Practice Address - Phone:813-901-9369
Practice Address - Fax:813-901-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 6469302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization