Provider Demographics
NPI:1922617729
Name:SYNERGYMD, LLC
Entity Type:Organization
Organization Name:SYNERGYMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-642-3164
Mailing Address - Street 1:1208 E KENNEDY BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3509
Mailing Address - Country:US
Mailing Address - Phone:813-642-3164
Mailing Address - Fax:877-457-1189
Practice Address - Street 1:1208 E KENNEDY BLVD STE 221
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3509
Practice Address - Country:US
Practice Address - Phone:813-642-3164
Practice Address - Fax:877-457-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty