Provider Demographics
NPI:1760070114
Name:PLYMOUTH-SORRENTO MEDICAL CENTER
Entity Type:Organization
Organization Name:PLYMOUTH-SORRENTO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ALBERTE
Authorized Official - Last Name:LABOSSIERE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-406-8583
Mailing Address - Street 1:24013 SORRENTO AVE
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9356
Mailing Address - Country:US
Mailing Address - Phone:352-406-8583
Mailing Address - Fax:
Practice Address - Street 1:30844 WESTRIDGE TER
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9356
Practice Address - Country:US
Practice Address - Phone:352-406-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center