MEDICARE: SOUTH FLORIDA BAPTIST HOSPITAL INC

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1265481238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA BAPTIST HOSPITAL INC

Provider Business Mailing Address
First Line	:	406 N REO ST
Second Line	:	SUITE 220
City	:	TAMPA
State	:	FL
Zip	:	33609-1063
Country	:	US
Telephone Number	:	813-636-2000
Fax Number	:	813-636-2050

Provider Business Practice Location Address
First Line	:	1603 W REYNOLDS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4735
Country	:	US
Telephone Number	:	813-759-1668
Fax Number	:	813-759-6903

Authorized Official
Title or Position	:	COO
Name	:	BILL ULBRICHT
Credential	:
Telephone Number	:	813-759-1668

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/27/2007

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