MEDICARE: SENIORS IN SERVICE OF TAMPA BAY, 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	372600000X	Adult Companion	5776	FL

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	:	1669781258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIORS IN SERVICE OF TAMPA BAY, INC.

Provider Business Mailing Address
First Line	:	1306 W. SLIGH AVENUE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5902
Country	:	US
Telephone Number	:	813-932-5228
Fax Number	:	813-932-9604

Provider Business Practice Location Address
First Line	:	1306 W. SLIGH AVENUE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5902
Country	:	US
Telephone Number	:	813-932-5228
Fax Number	:	813-932-9604

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MRS. GRACE H. PUTERMAN
Credential	:
Telephone Number	:	813-932-5228

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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