NPIMap

Organization Active NPI

Citrus Park Internal Medicine

  • Primary Care Clinic/Center
  • Tampa, FL
National Provider Identifier
1396949293
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ME82596 Issued in FL
Legal business name
CITRUS PARK INTERNAL MEDICINE
Practice address
16646 N Dale Mabry Hwy
Tampa, FL 33618-1400
Phone
(813) 908-5253
Fax
(813) 908-9100
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Pam Farley
Title
Office Manager
Phone
(813) 908-5253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X ME82596 FL Primary

Addresses

Primary practice location

16646 N Dale Mabry Hwy
Tampa, FL 33618-1400

Mailing address

PO Box 273788
Tampa, FL 33688-3788
Phone (813) 908-5253

Other names 1

  • LAKE PARK INTERNAL MEDICNE Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396949293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 273788",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336883788",
            "telephone_number": "813-908-5253",
            "fax_number": "813-908-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16646 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336181400",
            "telephone_number": "813-908-5253",
            "fax_number": "813-908-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS PARK INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "813-908-5253",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME82596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE PARK INTERNAL MEDICNE",
            "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 Aug 22, 2020; 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.