Provider Demographics
NPI:1598172090
Name:IDEAL MEDICAL CENTER OF TAMPA INC
Entity Type:Organization
Organization Name:IDEAL MEDICAL CENTER OF TAMPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-609-3983
Mailing Address - Street 1:6821 W HILLSBOROUGH AVE
Mailing Address - Street 2:UNIT 10-11
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5003
Mailing Address - Country:US
Mailing Address - Phone:813-609-3983
Mailing Address - Fax:
Practice Address - Street 1:6821 W HILLSBOROUGH AVE
Practice Address - Street 2:UNIT 10-11
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5003
Practice Address - Country:US
Practice Address - Phone:813-609-3983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty