Provider Demographics
NPI:1235117649
Name:HEALTHCARE CENTER OF TAMPA
Entity Type:Organization
Organization Name:HEALTHCARE CENTER OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOMSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-682-7246
Mailing Address - Street 1:202 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4548
Mailing Address - Country:US
Mailing Address - Phone:863-682-7246
Mailing Address - Fax:863-682-5566
Practice Address - Street 1:202 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4548
Practice Address - Country:US
Practice Address - Phone:863-682-7246
Practice Address - Fax:863-682-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM0070224261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32754Medicare ID - Type Unspecified
G63123Medicare UPIN