1184775173 NPI number — OSTOMY&URINARY CENTER OF TAMPA,INC.

Table of content: (NPI 1184775173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184775173 NPI number — OSTOMY&URINARY CENTER OF TAMPA,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTOMY&URINARY CENTER OF TAMPA,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:
O.U.C. MEDICAL
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:
1184775173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 EAST FLETCHER AVE.
Provider Second Line Business Mailing Address:
SUITE 137
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-265-2520
Provider Business Mailing Address Fax Number:
813-264-5931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 EAST FLETCHER AVE.
Provider Second Line Business Practice Location Address:
SUITE 137
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-265-2520
Provider Business Practice Location Address Fax Number:
813-264-5931
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YAZDI
Authorized Official First Name:
HOSSEIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/GENERAL MANAGER
Authorized Official Telephone Number:
813-265-2520

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1312510 , 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)





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