Provider Demographics
NPI:1518011386
Name:EXPRESS CARE OF TAMPA BAY, INC
Entity Type:Organization
Organization Name:EXPRESS CARE OF TAMPA BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-420-4254
Mailing Address - Street 1:6496 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1804
Mailing Address - Country:US
Mailing Address - Phone:813-651-4100
Mailing Address - Fax:813-651-4111
Practice Address - Street 1:107 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5111
Practice Address - Country:US
Practice Address - Phone:813-651-4100
Practice Address - Fax:813-651-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71027207R00000X, 207RC0200X
FLME79013207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB9962OtherRR MCARE GROUP
FLB903UOtherBCBS GROUP UC
FL10560801OtherCITRUS GROUP UC
FLMCAID ID #Medicaid
FLMCAID ID #Medicaid
FLDR RAHMANMedicare UPIN
FLMCARE ID #Medicare ID - Type UnspecifiedK5624