1497239743 NPI number — ORTHOPEDIC ASSOC OF TAMPA BAY LLC

Table of content: (NPI 1497239743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497239743 NPI number — ORTHOPEDIC ASSOC OF TAMPA BAY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOC OF TAMPA BAY LLC
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:
1497239743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7226 WILLIAMS DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33705-6158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-642-2432
Provider Business Mailing Address Fax Number:
727-667-6783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 N. ARMENIA AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33603-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-642-2432
Provider Business Practice Location Address Fax Number:
727-667-6783
Provider Enumeration Date:
09/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TAMEA
Authorized Official First Name:
CONRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
727-667-6783

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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