Provider Demographics
NPI:1184811846
Name:INJURY CARE INSTITUTE LLC
Entity type:Organization
Organization Name:INJURY CARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:YCAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-877-8177
Mailing Address - Street 1:829 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3309
Mailing Address - Country:US
Mailing Address - Phone:813-877-8177
Mailing Address - Fax:813-877-8277
Practice Address - Street 1:829 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3309
Practice Address - Country:US
Practice Address - Phone:813-877-8177
Practice Address - Fax:813-877-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-09-28
Deactivation Date:2007-10-04
Deactivation Code:
Reactivation Date:2007-10-18
Provider Licenses
StateLicense IDTaxonomies
FLOS7473261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service