# SOUTH CARE MEDICAL, LLC

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

## Provider details

- **NPI number:** 1982261681
- **Authorized official:** ALEJANDRO GONZALEZ (OWNER)
- **Authorized official phone:** (813) 770-7169

## Contact information

- **Practice address:** 6822 W WATERS AVE, TAMPA, FL 33634
- **Practice address phone:** (813) 969-1700
- **Mailing address:** 4522 W VILLAGE DR STE 202, TAMPA, FL 33624-3429
- **Mailing address phone:** (813) 969-1700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 05/29/2019
- **Last updated:** 05/29/2019