Provider Demographics
NPI:1255326302
Name:RMG IVF/ SURGERY CENTER LLC
Entity Type:Organization
Organization Name:RMG IVF/ SURGERY CENTER LLC
Other - Org Name:RMG IVF/ SURGERY CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-989-0120
Mailing Address - Street 1:5249 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1126
Mailing Address - Country:US
Mailing Address - Phone:813-989-0120
Mailing Address - Fax:813-989-0268
Practice Address - Street 1:5249 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1126
Practice Address - Country:US
Practice Address - Phone:813-989-0120
Practice Address - Fax:813-989-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1193261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6F9OtherBCBS NUMBER
FL10D1017148OtherCLIA