1780644583 NPI number — UNITED CEREBRAL PALSY OF TAMPA BAY, INC

Table of content: (NPI 1780644583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780644583 NPI number — UNITED CEREBRAL PALSY OF TAMPA BAY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CEREBRAL PALSY 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:
Provider Other Organization Name Type Code:
6
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:
1780644583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 E HENRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33610-4432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-239-1179
Provider Business Mailing Address Fax Number:
813-238-4605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 E HENRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33610-4432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-239-1179
Provider Business Practice Location Address Fax Number:
813-238-4605
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
813-239-1179

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04245 . This is a "STAY/WELL/HEALTH AKA ATA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6405222 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 900788 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4448226 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 204600 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: X0025 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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