Provider Demographics
NPI:1689287351
Name:TAMPA BAY MEDICAL MENTAL & BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:TAMPA BAY MEDICAL MENTAL & BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-485-8190
Mailing Address - Street 1:8910 N DALE MABRY HWY STE 17
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1580
Mailing Address - Country:US
Mailing Address - Phone:813-485-8190
Mailing Address - Fax:813-463-7975
Practice Address - Street 1:8910 N DALE MABRY HWY STE 17
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1580
Practice Address - Country:US
Practice Address - Phone:813-485-8190
Practice Address - Fax:813-463-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center