NPIMap

Organization Active NPI

Premium Health Services of Tampa

  • Urgent Care Clinic/Center
  • Brandon, FL
National Provider Identifier
1790060366
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
ME79013 Issued in FL
Legal business name
PREMIUM HEALTH SERVICES OF TAMPA
Practice address
107 W Robertson St
Brandon, FL 33511-5111
Phone
(813) 651-4100
Fax
(813) 651-4111
NPI assigned
Oct 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

Name
Dr. Khawaja A Rahman, MDNPI 1144298134
Title
President
Phone
(813) 651-4100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X ME79013 FL Primary

Addresses

Primary practice location

107 W Robertson St
Brandon, FL 33511-5111

Mailing address

6015 Rex Hall LN
Apollo Beach, FL 33572-2657
Phone (813) 690-7589

Other identifiers 2

IdentifierTypeStateIssuer
49283VOtherMEDICARE INDIVIDUAL
ME79013OtherFLMEDICAL LICENSE

Other names 1

  • express care of tampa bay Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Express Care of Tampa Bay3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1790060366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6015 REX HALL LN",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335722657",
            "telephone_number": "813-690-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W ROBERTSON ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115111",
            "telephone_number": "813-651-4100",
            "fax_number": "813-651-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM HEALTH SERVICES OF TAMPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "KHAWAJA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-651-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "ME79013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "49283V",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME79013",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "express care of tampa bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; 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.