Provider Demographics
NPI:1700387644
Name:CANO MEDICAL CENTER OF WEST FLORIDA LLC
Entity Type:Organization
Organization Name:CANO MEDICAL CENTER OF WEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLOW
Authorized Official - Middle Name:BLAS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-514-9360
Mailing Address - Street 1:4160 N ARMENIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6453
Mailing Address - Country:US
Mailing Address - Phone:813-673-8245
Mailing Address - Fax:954-432-0578
Practice Address - Street 1:4160 N ARMENIA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-673-8245
Practice Address - Fax:954-432-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11970OtherHEALTH CARE CLINIC