Provider Demographics
NPI:1922351477
Name:HIPPOCRATIC MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:HIPPOCRATIC MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODAMANTHOS
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOKOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-939-3090
Mailing Address - Street 1:1 N PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3415
Mailing Address - Country:US
Mailing Address - Phone:727-939-3090
Mailing Address - Fax:
Practice Address - Street 1:1 N PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3415
Practice Address - Country:US
Practice Address - Phone:727-939-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9106881207R00000X
FLME114286207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty