Provider Demographics
NPI:1174234355
Name:TAMPA GENERAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:TAMPA GENERAL MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP HEALTHCARE DESIGN
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:813-844-3829
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 1:1411 N WEST SHORE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4564
Practice Address - Country:US
Practice Address - Phone:813-844-3541
Practice Address - Fax:813-844-4283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA GENERAL MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty