Provider Demographics
NPI:1194042184
Name:ST. JOSEPH'S HOSPITAL TAMPA CARE CLINIC
Entity Type:Organization
Organization Name:ST. JOSEPH'S HOSPITAL TAMPA CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:813-870-4460
Mailing Address - Street 1:4600 N HABANA AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7112
Mailing Address - Country:US
Mailing Address - Phone:813-870-4460
Mailing Address - Fax:813-870-4459
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7112
Practice Address - Country:US
Practice Address - Phone:813-870-4460
Practice Address - Fax:813-870-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management