Provider Demographics
NPI:1760916696
Name:360 DEGREE MEDICAL CARE PA
Entity Type:Organization
Organization Name:360 DEGREE MEDICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-544-8300
Mailing Address - Street 1:10707 66TH ST N
Mailing Address - Street 2:STE. A
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2352
Mailing Address - Country:US
Mailing Address - Phone:727-544-8300
Mailing Address - Fax:727-544-8366
Practice Address - Street 1:10707 66TH ST N
Practice Address - Street 2:STE. A
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2352
Practice Address - Country:US
Practice Address - Phone:727-544-8300
Practice Address - Fax:727-544-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty