Basic Information
| Provider Information | |||||||||
| NPI: | 1417325515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAMPA FAMILY HEALTH CENTERS INC | ||||||||
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| OtherOrganizationName: | TAMPA FAMILY HEALTH CENTERS, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 E. FLETCHER AVENUE | ||||||||
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| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336123415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138660930 | ||||||||
| FaxNumber: | 8138660929 | ||||||||
| Practice Location | |||||||||
| Address1: | 5707 N 22ND ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336104350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137272244 | ||||||||
| FaxNumber: | 8138660929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2015 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | BOTTOMS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8138660930 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.