NPIMap

Organization Active NPI

Palm Medical Center Lakeland LLC

  • Clinic/Center
  • Tampa, FL
National Provider Identifier
1932796232
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PALM MEDICAL CENTER LAKELAND LLC
Practice address
116 W Bougainvillea Ave
Tampa, FL 33612-7437
Phone
(813) 932-4381
NPI assigned
Dec 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Fowad Choudhry
Title
Coo
Phone
(786) 814-4790

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

116 W Bougainvillea Ave
Tampa, FL 33612-7437

Mailing address

2600 S Douglas Rd Ste 308
Coral Gables, FL 33134-6134
Phone (786) 814-4790

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0290558Palm Medical Center Lakeland, LLC116 W Bougainvillea Avenue, Tampa, FL 33612Certificate of waiverJun 8, 2027

National Provider Directory

National Provider Directory

Locations

135 E 1st St
Lakeland, FL 33805
Phone (863) 686-2728

Practitioners & affiliated clinicians

Practitioners 7

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": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1932796232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S DOUGLAS RD STE 308",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331346134",
            "telephone_number": "786-814-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W BOUGAINVILLEA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127437",
            "telephone_number": "813-932-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM MEDICAL CENTER LAKELAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "CHOUDHRY",
        "authorized_official_first_name": "FOWAD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "786-814-4790"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.