1528004934 NPI number — NEUROSURGICAL ASSOCIATES OF TAMPA BAY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528004934 NPI number — NEUROSURGICAL ASSOCIATES OF TAMPA BAY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL ASSOCIATES OF TAMPA BAY, 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:
BRAIN2SPINE INSTITUTE
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:
1528004934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 7TH ST S
Provider Second Line Business Mailing Address:
SUITE 540
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-828-8400
Provider Business Mailing Address Fax Number:
727-828-8401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 7TH ST S STE 540
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-828-8411
Provider Business Practice Location Address Fax Number:
727-828-8401
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
NADINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
727-828-8400

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6697960001 . This is a "DME PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DC7963 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271117600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94728 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271117600 . 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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