Basic Information
| Provider Information | |||||||||
| NPI: | 1326203977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDITECH MEDICAL CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1783 S. KINGS AVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335116220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133159896 | ||||||||
| FaxNumber: | 8136624818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1783 S. KINGS AVE. | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335116220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133159896 | ||||||||
| FaxNumber: | 8136624818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARETTO | ||||||||
| AuthorizedOfficialFirstName: | PEDRO | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCIAL MGR | ||||||||
| AuthorizedOfficialTelephone: | 8133159896 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME100987 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.