Provider Demographics
NPI:1306995063
Name:MEDICAL DEVELOPMENT CORPORATION OF PASCO COUNTY, INC
Entity type:Organization
Organization Name:MEDICAL DEVELOPMENT CORPORATION OF PASCO COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-9563
Mailing Address - Street 1:PO BOX 5485
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5485
Mailing Address - Country:US
Mailing Address - Phone:727-868-9563
Mailing Address - Fax:727-869-6909
Practice Address - Street 1:7315 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1158
Practice Address - Country:US
Practice Address - Phone:727-868-9563
Practice Address - Fax:727-869-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL894261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLASC0000628OtherWORKMAN COMP
FL642OtherBLUE CROSS
FLASC0000628OtherWORKMAN COMP