Provider Demographics
NPI:1720641574
Name:TAMPA GENERAL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TAMPA GENERAL MEDICAL GROUP INC
Other - Org Name:TAMPA GENERAL HOSPITAL TRANSPLANT INSTITUTE FORT MYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CARE TRANSITIONS
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TRAVIS RIAD
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-844-3956
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-3956
Mailing Address - Fax:
Practice Address - Street 1:14131 METROPOLIS AVE STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4455
Practice Address - Country:US
Practice Address - Phone:239-224-3501
Practice Address - Fax:239-224-3525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA GENERAL MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty