Basic Information
| Provider Information | |||||||||
| NPI: | 1245823384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMERFIELD PRIMARY CARE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 WEBB RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336152865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132696426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10900 SE 174TH PLACE RD | ||||||||
| Address2: | |||||||||
| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344918984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132696426 | ||||||||
| FaxNumber: | 8133425261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2021 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | PULCINI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 8132696426 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.