Provider Demographics
NPI:1982314241
Name:BOKHARI MEDICAL CONSORTIUM INC
Entity Type:Organization
Organization Name:BOKHARI MEDICAL CONSORTIUM INC
Other - Org Name:BOKHARI MEDICAL CONSORTIUM
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTORY
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-229-8671
Mailing Address - Street 1:716 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3627
Mailing Address - Country:US
Mailing Address - Phone:727-238-3241
Mailing Address - Fax:727-238-8402
Practice Address - Street 1:716 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3627
Practice Address - Country:US
Practice Address - Phone:844-229-8671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health