Provider Demographics
NPI:1114927027
Name:TAMPA MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:TAMPA MEDICAL CARE, INC.
Other - Org Name:CHANDRA BAPNA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:BAPNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-931-2366
Mailing Address - Street 1:5106 N ARMENIA AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1433
Mailing Address - Country:US
Mailing Address - Phone:813-931-2366
Mailing Address - Fax:813-936-8886
Practice Address - Street 1:5106 N ARMENIA AVE STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1433
Practice Address - Country:US
Practice Address - Phone:813-931-2366
Practice Address - Fax:813-936-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068445207R00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379318400Medicaid
FL28453OtherBCBS
FL110150380OtherRR MEDICARE
FL201223OtherAMERIGROUP
FL246331OtherAVMED
FLME0068445OtherMEDICAL LICENSE
FL379318400Medicaid
FL28453OtherBCBS