Provider Demographics
NPI:1679379218
Name:HYDE PARK MEDICAL LLC
Entity type:Organization
Organization Name:HYDE PARK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMANUILIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-288-6358
Mailing Address - Street 1:301 W PLATT ST # A373
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2292
Mailing Address - Country:US
Mailing Address - Phone:813-314-7494
Mailing Address - Fax:
Practice Address - Street 1:301 W PLATT ST # A373
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2292
Practice Address - Country:US
Practice Address - Phone:813-314-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies