Provider Demographics
NPI:1598927147
Name:MORTON PLANT MEASE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MORTON PLANT MEASE HEALTH SERVICES INC
Other - Org Name:BARDMOOR OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-281-9390
Mailing Address - Street 1:PO BOX 404841
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4841
Mailing Address - Country:US
Mailing Address - Phone:813-852-3272
Mailing Address - Fax:813-852-3233
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-394-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07-0519500Medicaid
FLF1304Medicare PIN