Provider Demographics
NPI:1821294752
Name:FLORIDA PREMIER CARE PA
Entity Type:Organization
Organization Name:FLORIDA PREMIER CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-376-6578
Mailing Address - Street 1:PO BOX 340957
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-0957
Mailing Address - Country:US
Mailing Address - Phone:727-376-6578
Mailing Address - Fax:813-333-1214
Practice Address - Street 1:10006 CROSS CREEK BLVD
Practice Address - Street 2:#431
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2595
Practice Address - Country:US
Practice Address - Phone:727-376-6578
Practice Address - Fax:813-333-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97582208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL310820OtherAVMED
FL7865131OtherCIGNA
FL2804891OtherUNITED HEALTH CARE
FL90642OtherBCBSFL
FL9215095OtherAETNA
FL328027OtherAMERIGROUP
FL100725800Medicaid
FL15352001OtherCITRUS HEALTH CARE
FLME97582OtherMEDICAL LICENSE
FL9215095OtherAETNA