Provider Demographics
NPI:1497239743
Name:ORTHOPEDIC ASSOC OF TAMPA BAY LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOC OF TAMPA BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-667-6783
Mailing Address - Street 1:7226 WILLIAMS DR S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-6158
Mailing Address - Country:US
Mailing Address - Phone:727-642-2432
Mailing Address - Fax:727-667-6783
Practice Address - Street 1:4505 N. ARMENIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2746
Practice Address - Country:US
Practice Address - Phone:727-642-2432
Practice Address - Fax:727-667-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-23
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty