Basic Information
| Provider Information | |||||||||
| NPI: | 1386928844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3376 MARINER BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346092460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526843300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3376 MARINER BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346092460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526843300 | ||||||||
| FaxNumber: | 3526843222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | MALHOTRA | ||||||||
| AuthorizedOfficialFirstName: | POONAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3525845192 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME76833 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.