MAIN STREET MEDICAL LLC (NPI# 1487079505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487079505 |
| Entity Type | Organization |
| Organization Name | MAIN STREET MEDICAL LLC |
| Other Organization Name | MAIN STREET MEDICAL CENTERS |
| Practice Address |
10549 N Florida Ave Ste I Tampa FL 33612-6707 |
| Mailing Address |
Po Box 17175 Tampa FL 33682-7175 |
| Practice Telephone | 8132201400 |
| Mailing Telephone | 8132201400 |
| Mailing Fax Number | 8133414004 |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2020-07-07 |
| Authorized Official Name | MR. STEPHEN O BANJOKO (CFO) |
| Authorized Official Telephone | 2122570225 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 104624600 | 05 | |
| FL | MEDICARE | LK078 | 01 |
| Other Name | Type Code |
|---|---|
| MAIN STREET MEDICAL CENTERS | Doing Business As Name - Organization |
| MAIN STREET URGENT CARE | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 8900 N Armenia Ave Ste 206, Tampa, FL 336041072 | 8133414001 | 8133414004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134274103 | Main Street Medical LLC | Family Medicine | 6641 Kaniksu St, Suite A, Bonners Ferry, ID 83805-7532 | 2007-01-23 |
| Street Address |
10549 N FLORIDA AVE STE I |
| City | TAMPA |
| State | FL |
| Zip Code | 33612-6707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952330771 | Gregory F Saric | Family Medicine | 10549 N Florida Ave Ste I, Tampa, FL 33612-6707 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689286767 | Daniel Jimenez | Physical Therapist | 13000 Bruce B Downs Blvd, Tampa, Fl, Tampa, FL 33612 | 2020-08-19 |
| 1700426830 | Taz Stacy | Behavior Technician | 2701 University Square Drive, Tampa, FL 33612 | 2020-01-07 |
| 1841853215 | Eric Austen Keeler | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-20 |
| 1346700242 | Caitlyn Victoria Cartwright | Student in an Organized Health Care Education/Training Program | 12901 Bruce B. Downs Blvd., Mdc5, Tampa, FL 33612 | 2019-03-25 |
| 1720552953 | Marijo Bilitski | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd # Blvd5, Tampa, FL 33612 | 2019-01-22 |
| 1790259190 | Belkis Aleman | Nurse Practitioner | 205 E Busch Blvd, Tampa, FL 33612 | 2019-01-18 |
| 1811469133 | Stephanie Stegner | Physician Assistant | 12901 Bruce B Downs Blvd Mdc 5, Tampa, FL 33612 | 2018-12-27 |
| 1053889857 | Alysia Heather Siegel | Psychologist | 1300 Bruce B. Downs Boulevard, 116b, Tampa, FL 33612 | 2018-11-09 |
| 1295202489 | Daisy Baby Pulinilkumkalayil | Nurse Practitioner | 1426 W. Bush Blvd. Suite #105, Suite #105, Tampa, FL 33612 | 2018-10-26 |
| 1649745258 | Rachel Rene Shelton | Specialist/Technologist | Orthopedics and Sports Medicine, 13330 Usf Laurel Drive, Tampa, FL 33612 | 2018-10-10 |
| Find all providers in zip 33612 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1356976401 | Healthworks Med Group of Florida P A | Clinic/Center | 8705 Henderson Rd, Tampa, FL 33634-1143 | 2020-03-10 |
| 1720639453 | Careatc | Clinic/Center | 4107 N Himes Ave Ste 101, Tampa, FL 33607-6645 | 2019-09-24 |
| 1023572591 | Cheryl A Reed Md LLC | Clinic/Center | 6101 Webb Rd Ste 207, Tampa, FL 33615-2865 | 2019-01-29 |
| 1629579339 | Ohc Primary LLC | Clinic/Center | 912 Channelside Dr Ste 2103, Tampa, FL 33602-4227 | 2018-02-27 |
| 1649778663 | Florida Advanced Acupuncture | Clinic/Center | 14003 N Dale Mabry Hwy, Tampa, FL 33618-2459 | 2018-01-24 |
| 1174895411 | Inspire Medical Clinic LLC | Clinic/Center | 9804 North 56th St., Tampa, FL 33617 | 2012-02-02 |
| 1891064275 | Ar Enterprises of Hillsborough County | Clinic/Center | 6323 Memorial Hwy # D-1, Tampa, FL 33615-4509 | 2011-12-14 |
| 1568782134 | West Tampa Medical Clinic | Clinic/Center | 2309 W Martin Luther King Jr Blvd, Suite 5, Tampa, FL 33607 | 2010-06-07 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.