Provider Demographics
NPI:1023479193
Name:HEMWELL LLC
Entity type:Organization
Organization Name:HEMWELL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:SULZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-697-9355
Mailing Address - Street 1:4809 N ARMENIA AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1447
Mailing Address - Country:US
Mailing Address - Phone:855-697-9355
Mailing Address - Fax:866-435-4017
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:STE 106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:855-697-9355
Practice Address - Fax:866-435-4017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEMWELL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0095XOtherFL BLUE
FLIE479AMedicare PIN