Provider Demographics
NPI:1417078213
Name:TAMPA ORTHOPEDIC MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:TAMPA ORTHOPEDIC MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GISELA
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-875-7626
Mailing Address - Street 1:PO BOX 151896
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1896
Mailing Address - Country:US
Mailing Address - Phone:813-875-7626
Mailing Address - Fax:813-875-4167
Practice Address - Street 1:1914 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6510
Practice Address - Country:US
Practice Address - Phone:813-875-7626
Practice Address - Fax:813-875-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6030111N00000X
FLME36421208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty