Florida Medical Clinic, LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

FLORIDA MEDICAL CLINIC, LLC

Practice address

17401 Commerce Park Blvd Ste 108
Tampa, FL 33647-3507

Phone

(813) 782-8311

NPI assigned

Apr 30, 2007

Organization subpart

Yes

Parent organization

FLORIDA MEDICAL CLINIC, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joe I Delatorre

Title

Ceo

Phone

(813) 780-8440

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Florida Medical Clinic Pathology Lab Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Florida Medical Clinic, LLC

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1568425809

  O20050930000662

  Same enrollment

Part of

Florida Medical Clinic LLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1003036237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQ",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "813-780-1255",
            "fax_number": "813-780-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17401 COMMERCE PARK BLVD STE 108",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473507",
            "telephone_number": "813-782-8311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38117 Market Sq",
            "address_purpose": "LOCATION",
            "city": "Zephyrhills",
            "state": "FL",
            "postal_code": "335427505",
            "country_code": "US",
            "telephone_number": "813-779-7687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FLORIDA MEDICAL CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA MEDICAL CLINIC, LLC",
        "enumeration_date": "2007-04-30",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A",
        "authorized_official_last_name": "DELATORRE",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-780-8440"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "690006221",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "800020546",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Medical Clinic Pathology Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida Medical Clinic Pathology Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florida Medical Clinic LLC
• Florida Medical Clinic LLC
• Florida Medical Clinic LLC
• Florida Medical Clinic LLC
• Florida Medical Clinic LLC
• Florida Medical Clinic, LLC
• Florida Medical Clinic, LLC
• Florida Medical Clinic, LLC
• Florida Medical Clinic, LLC
• Florida Medical Clinic, LLC

• Anatomic Pathology & Clinical Pathology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.