MEDICARE: TAMPA FAMILY HEALTH 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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619641198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA FAMILY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 82969
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33682-2969
Country	:	US
Telephone Number	:	813-866-0930
Fax Number	:	813-405-3722

Provider Business Practice Location Address
First Line	:	3901 S WEST SHORE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1003
Country	:	US
Telephone Number	:	813-397-5300
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WENDY HOEFLICH
Credential	:
Telephone Number	:	813-599-6188

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/06/2021

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