Provider Demographics
NPI:1841829710
Name:TAMPA TELEMEDICINE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:TAMPA TELEMEDICINE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-362-2562
Mailing Address - Street 1:2918 MAGNOLIA TRCE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-8530
Mailing Address - Country:US
Mailing Address - Phone:833-362-2562
Mailing Address - Fax:888-640-9997
Practice Address - Street 1:2918 MAGNOLIA TRCE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-8530
Practice Address - Country:US
Practice Address - Phone:833-362-2562
Practice Address - Fax:888-640-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98126OtherSTATE LICENSE