Provider Demographics
NPI:1831508506
Name:METABOLIC MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:METABOLIC MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEONHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-826-0838
Mailing Address - Street 1:1120 BELCHER RD S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3315
Mailing Address - Country:US
Mailing Address - Phone:727-826-0838
Mailing Address - Fax:877-275-8431
Practice Address - Street 1:1120 BELCHER RD S
Practice Address - Street 2:SUITE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3315
Practice Address - Country:US
Practice Address - Phone:727-826-0838
Practice Address - Fax:877-275-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6672261QE0002X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care