Provider Demographics
NPI: | 1578800462 |
---|---|
Name: | TAMPA GENERAL MEDICAL GROUP INC |
Entity Type: | Organization |
Organization Name: | TAMPA GENERAL MEDICAL GROUP INC |
Other - Org Name: | TGH FAMILY CARE CENTER KENNEDY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF MEDICAL INFORMATICS OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | CHANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 813-844-3956 |
Mailing Address - Street 1: | PO BOX 1289 |
Mailing Address - Street 2: | |
Mailing Address - City: | TAMPA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33601-1289 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-844-3956 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2501 W KENNEDY BLVD |
Practice Address - Street 2: | |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33609 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-844-0344 |
Practice Address - Fax: | 813-254-0230 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-01-11 |
Last Update Date: | 2023-04-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |