Provider Demographics
NPI:1629402359
Name:GREATER TAMPA BAY PHYSICIANS PINELLAS, LLC
Entity Type:Organization
Organization Name:GREATER TAMPA BAY PHYSICIANS PINELLAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO/VP
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-771-7591
Mailing Address - Street 1:1100 62ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5620
Mailing Address - Country:US
Mailing Address - Phone:727-866-3166
Mailing Address - Fax:727-864-4043
Practice Address - Street 1:1100 62ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5620
Practice Address - Country:US
Practice Address - Phone:727-866-3166
Practice Address - Fax:727-864-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty