Basic Information
| Provider Information | |||||||||
| NPI: | 1194463737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAMPA GENERAL PROVIDER NETWORK INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TAMPA GENERAL HOSPITAL GASTRO GROUP OF THE PALM BEACHES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000-7370 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552353496 | ||||||||
| FaxNumber: | 8137243198 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 PGA BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334102825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616596543 | ||||||||
| FaxNumber: | 5616593533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARZBERG | ||||||||
| AuthorizedOfficialFirstName: | ABRAHAM | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5612533980 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TAMPA GENERAL PROVIDER NETWORK INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.