MEDICARE: TAMPA ORTHOPEDIC MEDICAL CENTER, 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	111N00000X	Chiropractor	CH6030	FL
2	208D00000X	General Practice Physician	ME36421	FL

General Provider Information

NPI Number	:	1417078213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA ORTHOPEDIC MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 151896
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-1896
Country	:	US
Telephone Number	:	813-875-7626
Fax Number	:	813-875-4167

Provider Business Practice Location Address
First Line	:	1914 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6510
Country	:	US
Telephone Number	:	813-875-7626
Fax Number	:	813-875-4167

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARIA GISELA KNUDSEN
Credential	:
Telephone Number	:	813-875-7626

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/11/2025

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