Provider Demographics
NPI:1831308949
Name:TAMPA BAY SURGICAL GROUP, LLP
Entity Type:Organization
Organization Name:TAMPA BAY SURGICAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-254-3016
Mailing Address - Street 1:2901 W BUSCH BLVD.
Mailing Address - Street 2:SUITE 707
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4569
Mailing Address - Country:US
Mailing Address - Phone:813-254-3016
Mailing Address - Fax:813-254-3019
Practice Address - Street 1:2901 W BUSCH BLVD
Practice Address - Street 2:STE 707
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4569
Practice Address - Country:US
Practice Address - Phone:813-254-3016
Practice Address - Fax:813-254-3019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA BAY SURGICAL GROUP, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLLP070000452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty