Provider Demographics
NPI:1427755503
Name:PRINCIPAL MEDICAL CENTER
Entity type:Organization
Organization Name:PRINCIPAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCISMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERERA ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-760-9531
Mailing Address - Street 1:4123 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6433
Mailing Address - Country:US
Mailing Address - Phone:813-374-7474
Mailing Address - Fax:813-374-7451
Practice Address - Street 1:4123 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6433
Practice Address - Country:US
Practice Address - Phone:813-374-7474
Practice Address - Fax:813-374-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy