# PREMIUM HEALTH SERVICES OF TAMPA BAY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Express Care of Tampa Bay
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538421664
- **Authorized official:** DR. KHAWAJA RAHMAN MD (OWNER)
- **Authorized official phone:** (813) 641-0068

## Contact information

- **Practice address:** 4018 HIGHVIEW RD., SEFFNER, FL 33584-4923
- **Practice address phone:** (813) 651-4100
- **Practice address fax:** (813) 651-4111
- **Mailing address:** 11752 E MLK BLVD, SEFFNER, FL 33584-4923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | ME79013 | FL | Yes |

## Other

- **Enumeration date:** 06/14/2012
- **Last updated:** 06/25/2019