Basic Information
| Provider Information | |||||||||
| NPI: | 1891462933 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TAMPA FAMILY HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82969 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336822969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138660930 | ||||||||
| FaxNumber: | 8134053722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 E BEARSS AVE | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133975300 | ||||||||
| FaxNumber: | 8136821288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2021 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOEFLICH | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8135996188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.