MEDICARE: VETERAM AFFAIRS- BAY PINES

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	2865M2000X	Military General Acute Care Hospital

General Provider Information

NPI Number	:	1265788012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERAM AFFAIRS- BAY PINES

Provider Business Mailing Address
First Line	:	4008 LADY PALM CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4008 LADY PALM CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2383
Country	:	US
Telephone Number	:	813-777-7407
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL SOCIAL WORKER
Name	:	MS. JENNIFER TRAWICK
Credential	:
Telephone Number	:	813-777-7407

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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