1023756475 NPI number — H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.

Table of content: (NPI 1023756475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023756475 NPI number — H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1023756475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12902 USF MAGNOLIA DRIVE
Provider Second Line Business Mailing Address:
MAILSTOP: MCC-PHARM
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-745-7354
Provider Business Mailing Address Fax Number:
813-745-1484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12902 USF MAGNOLIA DRIVE
Provider Second Line Business Practice Location Address:
MAILSTOP: MCC-PHARM
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-745-7354
Provider Business Practice Location Address Fax Number:
813-745-1484
Provider Enumeration Date:
05/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ALFONSO
Authorized Official First Name:
SOPHIA
Authorized Official Middle Name:
MARIELA
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
813-745-6085

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109430100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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