Provider Demographics
NPI:1508027657
Name:OCANA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:OCANA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:OCANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-968-8314
Mailing Address - Street 1:6529 GUNN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4021
Mailing Address - Country:US
Mailing Address - Phone:813-968-8314
Mailing Address - Fax:813-961-3096
Practice Address - Street 1:6529 GUNN HIGHWAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4021
Practice Address - Country:US
Practice Address - Phone:813-968-8314
Practice Address - Fax:813-961-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276616700Medicaid
FL173165Medicare UPIN