Provider Profile
MAIN STREET MEDICAL CENTERS
Health Care Clinic
FACILITY PROFILE
Street Address
- 10549 N FLORIDA AVE STE A
TAMPA, FL 33612-6707
County: Hillsborough - Phone: (813) 220-1400
Mailing Address
- P O BOX 17175
TAMPA, FL 33682
County: Hillsborough - Phone: (813) 220-1400
AHCA Reports
Inspection ReportsInspection Details
Facility Information:
| Facility/Provider Type: | Health Care Clinic | ||||||||||||
| Medical or Clinic Director: | MARK RICHARD LAFLAMME | ||||||||||||
| Administrator: | BAMIDELE C BANJOKO | ||||||||||||
| Owner/Licensee: | MAIN STREET MEDICAL LLC | ||||||||||||
| Owner/Licensee Since: | 4/30/2018 | ||||||||||||
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| Profit Status: | For-Profit | ||||||||||||
| Licensed Beds: | Not Available | ||||||||||||
| AHCA Number (File Number): | 12127 | ||||||||||||
| AHCA Field Office: | 06 | ||||||||||||
| License Number: | 11431 | ||||||||||||
| Current License Effective: | 11/4/2022 | ||||||||||||
| Current License Expires: | 11/3/2024 | ||||||||||||
| License Status: | IN REVIEW | ||||||||||||
Services/Characteristics
| Type: | Fixed Location |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.