# SANTURCE MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649725029
- **Authorized official:** DR. ORLANDO E MIELES MD (MD/CEO)
- **Authorized official phone:** (813) 651-0005

## Contact information

- **Practice address:** 500 VONDERBURG DR STE 305, BRANDON, FL 33511-5976
- **Practice address phone:** (813) 651-0005
- **Practice address fax:** (813) 902-7234
- **Mailing address:** 500 VONDERBURG DR, SUITE 305, BRANDON, FL 33511-5964
- **Mailing address phone:** (813) 624-9399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2016
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1700149143 | — | FL |