Provider Demographics
NPI:1124630652
Name:THREE STRIPE MCCRAY, LLC
Entity type:Organization
Organization Name:THREE STRIPE MCCRAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-ED, RN
Authorized Official - Phone:813-727-3011
Mailing Address - Street 1:13056 LONG PINE TRL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6530
Mailing Address - Country:US
Mailing Address - Phone:813-727-3011
Mailing Address - Fax:
Practice Address - Street 1:2507 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-2049
Practice Address - Country:US
Practice Address - Phone:813-727-3011
Practice Address - Fax:800-897-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory