Provider Demographics
NPI:1093993362
Name:TAMPA ORTHOTIC MANAGEMENT SERVICES, INC
Entity Type:Organization
Organization Name:TAMPA ORTHOTIC MANAGEMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HURLEY
Authorized Official - Last Name:ECKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOC, ABC
Authorized Official - Phone:813-886-9202
Mailing Address - Street 1:5537 SHELDON RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3167
Mailing Address - Country:US
Mailing Address - Phone:813-886-9202
Mailing Address - Fax:813-886-9223
Practice Address - Street 1:5537 SHELDON RD
Practice Address - Street 2:SUITE N
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3167
Practice Address - Country:US
Practice Address - Phone:813-886-9202
Practice Address - Fax:813-886-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT19335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL474446OtherWELLCARE
FL032624100Medicaid
FL1065307OtherCAREPLUS
FL613214800OtherOWCP DEPARTMNT OF LABOR
FLTAMP3870-0OtherCIGNA
FLM2843OtherBLUE CROSS BLUE SHIELD
FL14445OtherUNIVERSAL
FLM2843OtherBLUE CROSS BLUE SHIELD