Provider Demographics
NPI:1679223531
Name:SPCCSMDBRANDON INC
Entity Type:Organization
Organization Name:SPCCSMDBRANDON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:DIFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-244-1251
Mailing Address - Street 1:431 MANNS HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3314
Mailing Address - Country:US
Mailing Address - Phone:813-244-1251
Mailing Address - Fax:
Practice Address - Street 1:207 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4429
Practice Address - Country:US
Practice Address - Phone:813-244-1251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)