Provider Demographics
NPI:1083298137
Name:TAMPA GENERAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TAMPA GENERAL MEDICAL GROUP INC
Other - Org Name:TGMG PINELLAS PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CARE TRANSITIONS
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TRAVIS RIAD
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-844-3956
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-3956
Mailing Address - Fax:
Practice Address - Street 1:6088 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3231
Practice Address - Country:US
Practice Address - Phone:727-828-6360
Practice Address - Fax:727-828-6361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA GENERAL MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care