1093993362 NPI number — TAMPA ORTHOTIC MANAGEMENT SERVICES, INC

Table of content: (NPI 1093993362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093993362 NPI number — TAMPA ORTHOTIC MANAGEMENT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMPA ORTHOTIC MANAGEMENT SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1093993362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5537 SHELDON RD
Provider Second Line Business Mailing Address:
SUITE N
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33615-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-886-9202
Provider Business Mailing Address Fax Number:
813-886-9223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5537 SHELDON RD
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33615-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-886-9202
Provider Business Practice Location Address Fax Number:
813-886-9223
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ECKERSON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
HURLEY
Authorized Official Title or Position:
CERTIFIED ORTHOTIST/PRESIDENT
Authorized Official Telephone Number:
813-886-9202

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  ORT19 , 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: 474446 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 032624100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1065307 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 613214800 . This is a "OWCP DEPARTMNT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: TAMP3870-0 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: M2843 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14445 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com