| Organization Name: | PREMIUM HEALTH SERVICES OF TAMPA BAY |
| NPI Number: | 1538421664 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KHAWAJA RAHMAN (OWNER) |
| Mailing Address: | 11752 E Mlk Blvd Seffner |
| State: | FL US |
| Postal Code: | 335844923 |
| Phone Number: | 8136410068 |
| Fax Number: | |
| NPI Enumeration Date: | 06/14/2012 |
| NPI Last Update Date: | 01/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | ME79013 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |