Organization
PREMIUM HEALTH SERVICES OF TAMPA
Active
Other names
express care of tampa bay
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHAWAJA A RAHMAN MD (PRESIDENT)
(813) 651-4100
Entity
Organization
Contact information
Practice address
107 W ROBERTSON ST, BRANDON, FL 33511-5111
(813) 651-4100
(813) 651-4111
Mailing address
6015 REX HALL LN, APOLLO BEACH, FL 33572-2657
(813) 690-7589
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
ME79013
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49283V
MEDICARE INDIVIDUAL
—
01
—
ME79013
MEDICAL LICENSE
FL
Enumeration date
10/14/2011
Last updated
10/14/2011
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