Provider Demographics
NPI:1093917767
Name:P.V.C. MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:P.V.C. MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PLASENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-873-9369
Mailing Address - Street 1:3260 W HILLSBOROUGH AVE
Mailing Address - Street 2:# 111
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5902
Mailing Address - Country:US
Mailing Address - Phone:813-873-9369
Mailing Address - Fax:813-873-9386
Practice Address - Street 1:3260 W HILLSBOROUGH AVE
Practice Address - Street 2:# 111
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5902
Practice Address - Country:US
Practice Address - Phone:813-873-9369
Practice Address - Fax:813-873-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6469261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center