Provider Demographics
NPI:1912780727
Name:PLANET HEALTH MEDICAL CENTER AT TAMPA CORP
Entity Type:Organization
Organization Name:PLANET HEALTH MEDICAL CENTER AT TAMPA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-741-9281
Mailing Address - Street 1:10305 NW 41ST ST STE 115
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2975
Mailing Address - Country:US
Mailing Address - Phone:305-741-9281
Mailing Address - Fax:
Practice Address - Street 1:5101 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6902
Practice Address - Country:US
Practice Address - Phone:813-537-2100
Practice Address - Fax:813-537-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center