Provider Demographics
NPI:1982607321
Name:FAMILY PHYSICIANS OF TAMPA BAY
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-901-0705
Mailing Address - Street 1:5535 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7370
Mailing Address - Country:US
Mailing Address - Phone:813-901-0705
Mailing Address - Fax:813-888-5097
Practice Address - Street 1:5535 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7370
Practice Address - Country:US
Practice Address - Phone:813-901-0705
Practice Address - Fax:813-888-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI16188Medicare UPIN
FLD18830Medicare UPIN
FL80737XMedicare ID - Type UnspecifiedKOPITNIK MEDICARE
FL46521YMedicare ID - Type UnspecifiedKERN MEDICARE
FLI32743Medicare UPIN
FLC78637Medicare UPIN
FL29516BMedicare ID - Type UnspecifiedBENCOMO MEDICARE
FL03557ZMedicare ID - Type UnspecifiedVALENTIN MEDICARE
FLD53610Medicare UPIN