NPIMap

Organization Active NPI

Ed Medical Therapy Center, Inc.

  • General Practice Physician
  • Tampa, FL
National Provider Identifier
1790060333
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
HCC9274 Issued in FM
Legal business name
ED MEDICAL THERAPY CENTER, INC.
Practice address
4311 W Waters Ave
Suit #205
Tampa, FL 33614
Phone
(813) 407-1591
NPI assigned
Oct 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Authorized official

Name
Ms. Janis Gomez X, PRESIDENT
Title
President
Phone
(813) 407-1591

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X HCC9274 FM Primary

Addresses

Primary practice location

4311 W Waters Ave
Suit #205
Tampa, FL 33614

Mailing address

4311 W Waters Ave
Suite 205
Tampa, FL 33614
Phone (813) 407-1591

Other names 1

  • ED MEDICAL THERAPY CENTER, INC. Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1790060333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 W WATERS AVE",
            "address_2": "SUITE 205",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33614",
            "telephone_number": "813-407-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 W WATERS AVE",
            "address_2": "SUIT #205",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33614",
            "telephone_number": "813-407-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ED MEDICAL THERAPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "JANIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-407-1591",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_name_suffix": "X",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FM",
            "license": "HCC9274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ED MEDICAL THERAPY CENTER, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 May 5, 2015; 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.