Provider Demographics
NPI:1205116829
Name:ANISTA NEW TAMPA, LLC
Entity type:Organization
Organization Name:ANISTA NEW TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:III
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:813-972-2900
Mailing Address - Street 1:18101 HIGHWOODS PRESERVE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1791
Mailing Address - Country:US
Mailing Address - Phone:813-972-2900
Mailing Address - Fax:813-972-2910
Practice Address - Street 1:18101 HIGHWOODS PRESERVE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1791
Practice Address - Country:US
Practice Address - Phone:813-972-2900
Practice Address - Fax:813-972-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care