Provider Demographics
NPI:1023397817
Name:EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, LLC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, LLC
Other - Org Name:EXCELIS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DION
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SAMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-874-5707
Mailing Address - Street 1:P.O. BOX 24748
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623
Mailing Address - Country:US
Mailing Address - Phone:813-874-5707
Mailing Address - Fax:813-874-5908
Practice Address - Street 1:3001 W. DR. MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-870-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty