MEDICARE: HILLSBOROUGH COUNTY DEPARTMENT OF AGING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1174722920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSBOROUGH COUNTY DEPARTMENT OF AGING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1110
Second Line	:	AGING SERVICES, 25TH FLOOR
City	:	TAMPA
State	:	FL
Zip	:	33601-1110
Country	:	US
Telephone Number	:	813-272-5242
Fax Number	:	813-272-6862

Provider Business Practice Location Address
First Line	:	601 E KENNEDY BLVD
Second Line	:	AGING SERVICES, 25TH FLOOR
City	:	TAMPA
State	:	FL
Zip	:	33602-4156
Country	:	US
Telephone Number	:	813-272-5242
Fax Number	:	813-272-6862

Authorized Official
Title or Position	:	QUALITY MANAGER
Name	:	MR. SAM ELIZONDO
Credential	:	CPHQ
Telephone Number	:	813-272-5165

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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