NPIMap

Organization Active NPI

Palm Medical Center Lakeland LLC

  • General Practice Physician
  • Tampa, FL
National Provider Identifier
1073249348
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PALM MEDICAL CENTER LAKELAND LLC
Practice address
11017 N Dale Mabry Hwy Ste B
Tampa, FL 33618-3873
Phone
(813) 337-7402
Fax
(813) 461-6462
NPI assigned
Jul 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Authorized official

Name
Santiago Moises Martin
Title
President of Center Operations
Phone
(305) 913-9441

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

11017 N Dale Mabry Hwy Ste B
Tampa, FL 33618-3873

Mailing address

2600 S Douglas Rd Ste 308
Coral Gables, FL 33134-6134
Phone (813) 538-7880

Other identifiers 1

IdentifierTypeStateIssuer
016289500MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Palm Medical Center Lakelan36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1073249348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S DOUGLAS RD STE 308",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331346134",
            "telephone_number": "813-538-7880",
            "fax_number": "305-442-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11017 N DALE MABRY HWY STE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336183873",
            "telephone_number": "813-337-7402",
            "fax_number": "813-461-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM MEDICAL CENTER LAKELAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "MOISES MARTIN",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "PRESIDENT OF CENTER OPERATIONS",
        "authorized_official_telephone_number": "305-913-9441"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016289500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.