Provider Demographics
NPI:1255684593
Name:GREATER TAMPA MEDICINE INC
Entity Type:Organization
Organization Name:GREATER TAMPA MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-749-0393
Mailing Address - Street 1:442 W KENNEDY BLVD
Mailing Address - Street 2:250
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1400
Mailing Address - Country:US
Mailing Address - Phone:813-749-0393
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:442 W KENNEDY BLVD
Practice Address - Street 2:250
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1400
Practice Address - Country:US
Practice Address - Phone:813-749-0393
Practice Address - Fax:727-828-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty