Provider Demographics
NPI:1013385004
Name:OPES HEALTH CHANNELSIDE LLC
Entity Type:Organization
Organization Name:OPES HEALTH CHANNELSIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-397-3632
Mailing Address - Street 1:109 N 12TH ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3686
Mailing Address - Country:US
Mailing Address - Phone:813-906-6737
Mailing Address - Fax:855-916-6737
Practice Address - Street 1:912 CHANNELSIDE DR
Practice Address - Street 2:SUITE 2103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4229
Practice Address - Country:US
Practice Address - Phone:813-906-6737
Practice Address - Fax:855-916-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015842000Medicaid
FLIJ945AMedicare PIN