Provider Demographics
NPI:1598118606
Name:UNIVERSITY OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ASSOCIATE ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHULSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:813-974-6794
Mailing Address - Street 1:4202 E FOWLER AVE
Mailing Address - Street 2:ATH100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-8000
Mailing Address - Country:US
Mailing Address - Phone:813-974-6794
Mailing Address - Fax:813-974-8541
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:ATH100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-8000
Practice Address - Country:US
Practice Address - Phone:813-974-6794
Practice Address - Fax:813-974-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL2936302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization