Provider Demographics
NPI:1306237672
Name:MEDITECH MEDICAL CENTERS, LLC
Entity type:Organization
Organization Name:MEDITECH MEDICAL CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-315-9896
Mailing Address - Street 1:1783 S KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6220
Mailing Address - Country:US
Mailing Address - Phone:813-315-9896
Mailing Address - Fax:813-662-4818
Practice Address - Street 1:5110 N HABANA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6909
Practice Address - Country:US
Practice Address - Phone:813-915-9000
Practice Address - Fax:813-930-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86710208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBO794AMedicare UPIN