Florida Medical Clinic, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800006196 Issued in FL

Legal business name

FLORIDA MEDICAL CLINIC, LLC

Practice address

17401 Commerce Park Blvd Ste 107
Tampa, FL 33647-3507

Phone

(813) 782-8311

NPI assigned

Apr 8, 2006

Last updated

Feb 21, 2020By the provider in NPPES

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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Florida Medical Clinic LLC

  dba Florida Medical Clinic Rehabilitation Center

  • Rehabilitation Clinic/Center
  • Zephyrhills, FL
  • NPI 1710053368

  9931003068

  Same PAC ID
• Florida Medical Clinic LLC

  • Clinic/Center
  • Zephyrhills, FL
  • NPI 1821055690

  9931003068

  Same PAC ID

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

  dba Florida Medical Clinic Pathology Lab

  • Anatomic Pathology & Clinical Pathology Physician
  • Tampa, FL
  • NPI 1003036237

  O20050930000662

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Florida Medical Clinic LLC

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1568425809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQUARE",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "33542",
            "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 107",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473507",
            "telephone_number": "813-782-8311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38135 Market Square",
            "address_purpose": "LOCATION",
            "city": "Zephyrhills",
            "state": "FL",
            "postal_code": "33542",
            "country_code": "US",
            "telephone_number": "813-782-8311",
            "fax_number": "813-783-8204",
            "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": "2006-04-08",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800006196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "690006221",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 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

• Clinical Medical Laboratory in Tampa, FL
• Providers in Tampa, FL by specialty
• Clinical Medical Laboratory 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.