1114145463 NPI number — TAMPA BAY MEDICAL REHAB INC.

Table of content: (NPI 1114145463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114145463 NPI number — TAMPA BAY MEDICAL REHAB INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMPA BAY MEDICAL REHAB INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAMPA BAY MEDICAL CARE GROUP INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114145463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 N DALE MABRY HWY
Provider Second Line Business Mailing Address:
SUITE 198-B
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-3997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-935-1944
Provider Business Mailing Address Fax Number:
813-884-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 N DALE MABRY HWY
Provider Second Line Business Practice Location Address:
SUITE 198-B
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-935-1944
Provider Business Practice Location Address Fax Number:
813-884-1955
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMARO
Authorized Official First Name:
YUSDANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
813-935-1944

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME56636 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111162100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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