Provider Demographics
NPI:1003840091
Name:NEW TAMPA UROLOGY P A
Entity Type:Organization
Organization Name:NEW TAMPA UROLOGY P A
Other - Org Name:NEW TAMPA UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:WILLIAMSON
Authorized Official - Last Name:STARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-558-9091
Mailing Address - Street 1:5332 PRIMROSE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3589
Mailing Address - Country:US
Mailing Address - Phone:813-558-9091
Mailing Address - Fax:813-866-3948
Practice Address - Street 1:5332 PRIMROSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3589
Practice Address - Country:US
Practice Address - Phone:813-558-9091
Practice Address - Fax:813-866-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68367208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259650400Medicaid
FLG26670Medicare UPIN
FL259650400Medicaid