NPIMap

Organization Active NPI

Medical Home Alliance LLC

  • Non-Pharmacy Dispensing Site
  • Tampa, FL
National Provider Identifier
1194239780
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ACN515 Issued in FL
Legal business name
MEDICAL HOME ALLIANCE LLC
Practice address
4700 N Habana Ave
Tampa, FL 33614-7160
Phone
(813) 444-9599
Fax
(813) 513-8210
NPI assigned
Nov 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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

Authorized official

Name
Patricia D Perez
Title
Coo
Phone
(407) 845-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ACN515 FL Primary

Addresses

Primary practice location

4700 N Habana Ave
Tampa, FL 33614-7160

Mailing address

6675 Westwood Blvd Ste 475
Orlando, FL 32821-6027
Phone (407) 845-0330

Other identifiers 1

IdentifierTypeStateIssuer
018418600MedicaidFL

Other names 1

  • IMA West Tampa Dispensary Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Home Alliance LLC37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1194239780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6675 WESTWOOD BLVD STE 475",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328216027",
            "telephone_number": "407-845-0330",
            "fax_number": "888-972-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N HABANA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147160",
            "telephone_number": "813-444-9599",
            "fax_number": "813-513-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL HOME ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "407-845-0330"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ACN515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018418600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMA West Tampa Dispensary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 20, 2017; 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.