Provider Demographics
NPI:1699940718
Name:TOWN AND COUNTRY MEDICAL GROUP, LLC.
Entity type:Organization
Organization Name:TOWN AND COUNTRY MEDICAL GROUP, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-888-8215
Mailing Address - Street 1:5901 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3219
Mailing Address - Country:US
Mailing Address - Phone:813-888-8215
Mailing Address - Fax:
Practice Address - Street 1:5901 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3219
Practice Address - Country:US
Practice Address - Phone:813-888-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035878261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF37523Medicare UPIN
FLE60545Medicare UPIN