Provider Demographics
NPI:1386426484
Name:GO MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:GO MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-442-9192
Mailing Address - Street 1:7345 JACKSON SPRINGS RD STE C-2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4754
Mailing Address - Country:US
Mailing Address - Phone:813-549-2940
Mailing Address - Fax:813-549-2952
Practice Address - Street 1:7345 JACKSON SPRINGS RD # C-2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4754
Practice Address - Country:US
Practice Address - Phone:813-549-2940
Practice Address - Fax:813-549-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care