Basic Information
| Provider Information | |||||||||
| NPI: | 1275108854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME ENDOCRINOLOGY OF TAMPA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274990356 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Practice Location | |||||||||
| Address1: | 8837 CITRUS PALM DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336264735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274990356 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2021 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | SWAMI | ||||||||
| AuthorizedOfficialFirstName: | ARCHANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7274990356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | ME134258 | 01 | FL | LICENSE | OTHER |