Provider Demographics
NPI:1184946857
Name:TOWN MEDICAL AND REHAB CENTER
Entity type:Organization
Organization Name:TOWN MEDICAL AND REHAB CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-877-6530
Mailing Address - Street 1:PO BOX 20451
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0451
Mailing Address - Country:US
Mailing Address - Phone:813-877-6530
Mailing Address - Fax:813-877-6556
Practice Address - Street 1:3214 W TAMPA BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6616
Practice Address - Country:US
Practice Address - Phone:813-877-6530
Practice Address - Fax:813-877-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6954305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID