Basic Information
| Provider Information | |||||||||
| NPI: | 1598097222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARPON SPRINGS HOSPITAL FOUNDATION INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HELEN ELLIS MEMORIAL HOSPITAL PHYSICIANS GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 ALTERNATE 19 SOUTH | ||||||||
| Address2: | SUITE J | ||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346893790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279433642 | ||||||||
| FaxNumber: | 7279429745 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 ALTERNATE 19 SOUTH | ||||||||
| Address2: | SUITE J | ||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346893790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279433642 | ||||||||
| FaxNumber: | 7279429745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | HEINRICH | ||||||||
| AuthorizedOfficialFirstName: | CALEB | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7279425107 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.