Provider Demographics
NPI:1740623651
Name:TAMPA BAY IPA, INC
Entity type:Organization
Organization Name:TAMPA BAY IPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-512-2699
Mailing Address - Street 1:1508 SEAGULL DR
Mailing Address - Street 2:UNIT 104
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2450
Mailing Address - Country:US
Mailing Address - Phone:727-512-2699
Mailing Address - Fax:888-983-6442
Practice Address - Street 1:1508 SEAGULL DR
Practice Address - Street 2:UNIT 104
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2450
Practice Address - Country:US
Practice Address - Phone:727-512-2699
Practice Address - Fax:888-983-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management