| Phoenix American Medical LLC | |
|
1030 S 78th St Tampa FL 33619-4750 | |
| (813) 740-0646 | |
| (813) 609-3733 |
| Full Name | Phoenix American Medical LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1030 S 78th St, Tampa, Florida |
| Authorized Official Name and Position | Azzam Muftah (OWNER) |
| Authorized Official Contact | 3522775348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix American Medical LLC 14690 Spring Hill Dr Ste 101 Spring Hill FL 34609-8102 Ph: (352) 428-7817 | Phoenix American Medical LLC 1030 S 78th St Tampa FL 33619-4750 Ph: (813) 740-0646 |
| NPI Number | 1649784489 |
|---|---|
| Provider Enumeration Date | 11/30/2017 |
| Last Update Date | 11/13/2023 |
| Certification Date | 11/13/2023 |
| Medicare PECOS PAC ID | 1052672490 |
|---|---|
| Medicare Enrollment ID | O20180228001506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649784489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Dalton M Benson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164477618 PECOS PAC ID: 7012999816 Enrollment ID: I20040607001049 |
| Provider Name | Charles Russel Friend |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184638868 PECOS PAC ID: 8022053263 Enrollment ID: I20080428000381 |
| Provider Name | Mangesh B Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194781443 PECOS PAC ID: 0143364240 Enrollment ID: I20110224000904 |
| Provider Name | Santos Ruiz Cordero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598976557 PECOS PAC ID: 0143292797 Enrollment ID: I20141027000459 |
| Provider Name | Vinayal Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952801649 PECOS PAC ID: 7012247430 Enrollment ID: I20190927002513 |
| Provider Name | Francisco Rodriguez Fernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174056543 PECOS PAC ID: 2567738578 Enrollment ID: I20220502001144 |
| Provider Name | Stacy Lena Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316714207 PECOS PAC ID: 4385094010 Enrollment ID: I20231221001191 |
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