Provider Demographics
NPI:1326212200
Name:TBA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:TBA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-932-1300
Mailing Address - Street 1:3707 W HAMILTON AVE
Mailing Address - Street 2:SUITE# 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4067
Mailing Address - Country:US
Mailing Address - Phone:813-932-1300
Mailing Address - Fax:
Practice Address - Street 1:3707 W HAMILTON AVE
Practice Address - Street 2:SUITE# 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4067
Practice Address - Country:US
Practice Address - Phone:813-932-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6653261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation