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Contact Information

ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC
131 N MOON AVE
SUITES 3 & 4
BRANDON, FL33510-4418
 Phone: 813-315-9898
 Fax: 813-438-5967
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
 

Addiction Medicine

207QA0401X 08 Physician/Family Practice
 

Clinical Pharmacology

208U00000X
 

Dietary Manager

132700000X
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Personal Emergency Response Attendant

146D00000X
 

Public Health & General Preventive Medicine

2083P0901X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC

NPI Number 1518260090
LBN Legal business name ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC
Authorized official GODWIN OKOYE - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/06/2010
Last updated 10/08/2013 - About 13 years ago
Identifiers
FL License # ME107980
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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