MEDICARE: ORTHOPAEDIC MEDICAL GROUP OF TAMPA BAY PA

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207X00000X	Orthopaedic Surgery Physician

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	:	1710363957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC MEDICAL GROUP OF TAMPA BAY PA

Provider Business Mailing Address
First Line	:	PO BOX 850001 DEPT 8272
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32885-8272
Country	:	US
Telephone Number	:	813-684-2663
Fax Number	:	813-441-7161

Provider Business Practice Location Address
First Line	:	4541 S DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611
Country	:	US
Telephone Number	:	813-684-2663
Fax Number	:	813-877-3017

Authorized Official
Title or Position	:	M.D.
Name	:	DR. SCOTT GOLDSMITH
Credential	:	M.D.
Telephone Number	:	813-684-2663

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	10/22/2024

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