Provider Demographics
NPI:1851562367
Name:TAMPA FAMILY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:TAMPA FAMILY HEALTH CENTERS INC
Other - Org Name:TAMPA COMMUNITY HEALTH CENTER #31
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOTTOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-866-0930
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:6216 SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-9105
Practice Address - Country:US
Practice Address - Phone:813-549-8060
Practice Address - Fax:813-866-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101893Medicare Oscar/Certification
FL029548503Medicaid