Provider Demographics
NPI:1790830800
Name:GASTROENTEROLOGY SPECIALISTS OF TAMPA BAY
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-930-8816
Mailing Address - Street 1:3633 LITTLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1815
Mailing Address - Country:US
Mailing Address - Phone:727-372-5547
Mailing Address - Fax:727-372-5976
Practice Address - Street 1:7171 N DALE MABRY HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2630
Practice Address - Country:US
Practice Address - Phone:813-930-8816
Practice Address - Fax:813-932-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275238700Medicaid
FL275993400Medicaid
FL275993401Medicaid
FL275238700Medicaid
FLK8613AMedicare PIN