Provider Demographics
NPI:1568914935
Name:PREFERRED INJURY PHYSICIANS OF TOWN & COUNTRY INC
Entity Type:Organization
Organization Name:PREFERRED INJURY PHYSICIANS OF TOWN & COUNTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:ST-LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-317-9067
Mailing Address - Street 1:5411 BEAUMONT CENTER BLVD
Mailing Address - Street 2:SUITE 785
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5260
Mailing Address - Country:US
Mailing Address - Phone:407-900-7246
Mailing Address - Fax:
Practice Address - Street 1:5411 BEAUMONT CENTER BLVD
Practice Address - Street 2:SUITE 785
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5260
Practice Address - Country:US
Practice Address - Phone:407-900-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10487261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center