Provider Demographics
NPI:1730329335
Name:PHYSICIANS HEALTH INC.
Entity type:Organization
Organization Name:PHYSICIANS HEALTH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-875-5000
Mailing Address - Street 1:2707 N HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2113
Mailing Address - Country:US
Mailing Address - Phone:813-875-5000
Mailing Address - Fax:813-879-7211
Practice Address - Street 1:2707 N HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2113
Practice Address - Country:US
Practice Address - Phone:813-875-5000
Practice Address - Fax:813-879-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 4753261Q00000X
FLHCC 4752261Q00000X
FLHCC 4808261Q00000X
FLHCC 4813261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center