GLORY MEDCLINIC, LLC (NPI# 1427472364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427472364 |
| Entity Type | Organization |
| Organization Name | GLORY MEDCLINIC, LLC |
| Practice Address |
8019 N Himes Ave Suite 200 Tampa FL 33614-2712 |
| Practice Telephone | 8139329798 |
| Practice Fax Number | 8139355178 |
| Mailing Telephone | 8139329798 |
| Mailing Fax Number | 8139355178 |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-12 |
| Authorized Official Name | DR. DAVID OMOTAYO IKUDAYISI (PRESIDENT) |
| Authorized Official Telephone | 8139329798 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
FL | Ambulatory Health Care Facilities |
| Street Address |
8019 N HIMES AVE SUITE 200 |
| City | TAMPA |
| State | FL |
| Zip Code | 33614-2712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265403885 | Enid Staller Gildar | Speech-Language Pathologist | 8019 N Himes Ave, Suite 300, Tampa, FL 33614-2712 | 2006-01-31 |
| 1194005371 | Bayshore Home Health Care, Inc. | Home Health | 8019 N Himes Ave, Suite 103, Tampa, FL 33614-2712 | 2011-08-19 |
| 1720313489 | Crystal Rehabilitation Center, Inc. | Clinic/Center | 8019 N Himes Ave, Ste 102, Tampa, FL 33614-2712 | 2009-10-13 |
| 1972763860 | Walter Borjas | Massage Therapist | 8019 N Himes Ave, Suite 403, Tampa, FL 33614-2712 | 2008-06-13 |
| 1912171992 | Hbc Professional Group, Inc. | Clinic/Center | 8019 N Himes Ave, Suite 403, Tampa, FL 33614-2712 | 2008-04-21 |
| 1265619746 | Larry T Legg II Lcsw LLC | Community/Behavioral Health | 8019 N Himes Ave, Suite 311, Tampa, FL 33614-2712 | 2008-01-27 |
| 1275744518 | Aleida Esabel Hernandez | Counselor | 8019 N Himes Ave, Suite #400, Tampa, FL 33614-2712 | 2007-05-25 |
| 1538377973 | Kristen A. Hudacek, Psy.d., Plc | Community/Behavioral Health | 8019 N Himes Ave, Suite 400, Tampa, FL 33614-2712 | 2007-05-18 |
| 1265659668 | Michelle Robin Miller | Counselor | 8019 N Himes Ave, Suite 400, Tampa, FL 33614-2712 | 2007-04-19 |
| 1639393986 | Richard Enrico Spana | Psychologist | 8019 N Himes Ave, Suite 400, Tampa, FL 33614-2712 | 2007-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134733082 | Robin Rollena Stewart | Home Health | 9537 Lazy Lane, Apt 302, Tampa, FL 33614 | 2020-09-08 |
| 1346885761 | David Joseph Page | Nurse Practitioner | St. Joseph's Behavioral Health Center, 4918 N. Habana Ave, Tampa, FL 33614 | 2019-11-08 |
| 1134687411 | Ramon Chang Adult Family Care Home LLC | Custodial Care Facility | 2607 W Humphrey St, Tampa, FL 33614 | 2019-03-06 |
| 1134600612 | Senior Point Assisted Living Facility, LLC | Assisted Living Facility | 2940 W Hillsborough Ave, Tampa, FL 33614 | 2018-08-23 |
| 1306361266 | Larry Valdes | Assisted Living Facility | 4402 W Minnehaha St, Tampa, FL 33614 | 2017-08-11 |
| 1982128062 | Jaime F Casellas Md Corp | Internal Medicine | 4600 N Habana Ave Suit #13, Tampa, FL 33614 | 2017-07-31 |
| 1891219119 | Waveney Gittens-williams | Alzheimer Center (Dementia Center) | 3706 W. Idle Wild Cir #203, Tampa, FL 33614 | 2017-07-28 |
| 1750811857 | Syerita Nicole Morris | Counselor | 6800 N Dale Marby Hwy, Ste 164, Tampa, FL 33614 | 2017-06-13 |
| 1447786124 | Lisa Moy | Case Manager/Care Coordinator | 4001 W. Dr. Martin Luther King Jr. Blvd., Tampa, FL 33614 | 2017-05-02 |
| 1750813804 | Joshua Martin Good | Physical Therapy Assistant | 3363 W. Waters Avenue, Suite 700, Tampa, FL 33614 | 2017-03-29 |
| Find all providers in zip 33614 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386252534 | Florida Medical Labs Inc | Clinic/Center | 2901 W Busch Blvd Ste 206, Tampa, FL 33618-4564 | 2020-07-14 |
| 1114403227 | Robust Pain & Wellness Medical Center Inc | Clinic/Center | 3105 W Waters Ave Ste 210, Tampa, FL 33614-2873 | 2018-07-12 |
| 1720599137 | United States Management | Clinic/Center | 1419 W Waters Ave Ste 105, Tampa, FL 33604-2896 | 2017-10-12 |
| 1891240693 | Nuessence LLC | Clinic/Center | 18001 Malakai Isle Dr, Tampa, FL 33647-2991 | 2016-08-22 |
| 1306220777 | Medical A Center Inc | Clinic/Center | 7825 N Dale Marby Hwy, Ste 27, Tampa, FL 33614 | 2015-07-16 |
| 1144615196 | Balanced Health, Pllc | Clinic/Center | 11327 Countryway Blvd, Tampa, FL 33626-2610 | 2015-04-06 |
| 1134539273 | Lotus Path Wellness Center | Clinic/Center | 3642 Madaca Ln, Tampa, FL 33618-2057 | 2014-04-29 |
| 1689091050 | Dcreasequeen, Inc. | Clinic/Center | 11634 Bristol Chase Dr, Tampa, FL 33626-3300 | 2014-03-24 |
| 1790127249 | Ferrer Medical Center | Clinic/Center | 8313 W Hillsborough Ave Ste 260, Tampa, FL 33615-3818 | 2013-07-25 |
| 1205278264 | Century Health Center | Clinic/Center | 7402 N 56th St Bldg 900, Suite 907, Tampa, FL 33617-7733 | 2013-07-18 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.