Provider Demographics
NPI: | 1700061223 |
---|---|
Name: | SUPERIOR MEDICAL CLINICS LLC |
Entity Type: | Organization |
Organization Name: | SUPERIOR MEDICAL CLINICS LLC |
Other - Org Name: | PHYSICAL THERAPY NOW OF TEMPLE TERRACE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | IKE |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | OKEKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 813-549-7460 |
Mailing Address - Street 1: | 9780 N 56TH ST # C |
Mailing Address - Street 2: | |
Mailing Address - City: | TEMPLE TERRACE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33617-5508 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-549-7465 |
Mailing Address - Fax: | 813-549-7399 |
Practice Address - Street 1: | 9780 N 56TH ST STE C |
Practice Address - Street 2: | |
Practice Address - City: | TEMPLE TERRACE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33617-5546 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-549-7465 |
Practice Address - Fax: | 813-549-7399 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-01-03 |
Last Update Date: | 2024-04-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | HCC7887 | 261QM1300X, 261QH0100X, 261QM1300X, 261QP2300X, 261QP3300X |
103TP2701X, 207Q00000X, 207R00000X, 207X00000X, 2084P0800X, 208D00000X, 261QI0500X, 261QM1300X, 261QP2000X, 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | Group - Multi-Specialty |
No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | Group - Multi-Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |