Provider Demographics
NPI:1881216224
Name:GASTROENTEROLOGY CENTER OF TAMPA BAY LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF TAMPA BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:DIPASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-757-4810
Mailing Address - Street 1:602 VONDERBURG DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5900
Mailing Address - Country:US
Mailing Address - Phone:813-685-5500
Mailing Address - Fax:
Practice Address - Street 1:602 VONDERBURG DR STE 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5900
Practice Address - Country:US
Practice Address - Phone:813-685-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DIGESTIVE HEALTH SPECIALISTS LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty