1568496586 NPI number — HEMATOLOGY ONCOLOGY SPECIALISTS OF TAMPA

Table of content: (NPI 1568496586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568496586 NPI number — HEMATOLOGY ONCOLOGY SPECIALISTS OF TAMPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY ONCOLOGY SPECIALISTS OF TAMPA
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:
1568496586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4612 N HABANA AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-7112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-875-2341
Provider Business Mailing Address Fax Number:
813-877-3889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4612 N HABANA AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-7112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-875-2341
Provider Business Practice Location Address Fax Number:
813-877-3889
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALTEMOSE
Authorized Official First Name:
RAND
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-875-2341

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  072100000032 , 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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