Provider Demographics
NPI:1164173027
Name:TAMPA BAY PRIMARY CARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:TAMPA BAY PRIMARY CARE ASSOCIATES PLLC
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:BARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:813-252-6114
Mailing Address - Street 1:320 W FLETCHER AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3400
Mailing Address - Country:US
Mailing Address - Phone:813-252-6114
Mailing Address - Fax:813-566-1781
Practice Address - Street 1:320 W FLETCHER AVE STE 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3400
Practice Address - Country:US
Practice Address - Phone:813-252-6114
Practice Address - Fax:813-566-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113298500Medicaid