Provider Demographics
NPI:1679387278
Name:PIONEER MEDICAL GROUP CLINIC FOUNDATION
Entity type:Organization
Organization Name:PIONEER MEDICAL GROUP CLINIC FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-943-7784
Mailing Address - Street 1:13067 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0926
Mailing Address - Country:US
Mailing Address - Phone:813-450-7231
Mailing Address - Fax:786-868-0001
Practice Address - Street 1:3500 E FLETCHER AVE STE 222
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4712
Practice Address - Country:US
Practice Address - Phone:813-450-7231
Practice Address - Fax:786-868-0001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER MEDICAL GROUP, PL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care