Basic Information
| Provider Information | |||||||||
| NPI: | 1851718811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TAMPA FAMILY HEALTH CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TAMPA FAMIL HEALTH CENTER 29 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82969 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336822969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138660930 | ||||||||
| FaxNumber: | 8138660929 | ||||||||
| Practice Location | |||||||||
| Address1: | 5611 SHELDON RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336153532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133975320 | ||||||||
| FaxNumber: | 8134053924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 03/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | BOTTOMS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8138660930 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | PH27572 | FL | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.