Provider Demographics
NPI:1629560545
Name:UPSHAW TMS LLC
Entity Type:Organization
Organization Name:UPSHAW TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF HR, COMPLIANCE & CORP ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-605-1122
Mailing Address - Street 1:6511 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6511 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4021
Practice Address - Country:US
Practice Address - Phone:813-731-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
FLME96275251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME96275OtherMEDICAL LICENSE