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NPI Code Detail

MEDICARE: UNITED CEREBRAL PALSY OF TAMPA BAY, INC

MEDICARE: UNITED CEREBRAL PALSY 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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104245OTHERFLSTAY/WELL/HEALTH AKA ATA
26405222OTHERFLUNITED HEALTH CARE
3900788OTHERFLAETNA HMO
44448226OTHERFLAETNA PPO
5204600OTHERFLAMERIGROUP
6X0025OTHERFLBCBS

General Provider Information

NPI Number : 1780644583
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED CEREBRAL PALSY OF TAMPA BAY, INC
Provider Business Mailing Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-238-4605
Provider Business Practice Location Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-238-4605
Authorized Official
Title or Position : COO
Name : DAVID BROOKS
Credential :
Telephone Number : 813-239-1179
Provider Enumeration Date : 03/24/2006
Last Update Date : 08/22/2020

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Directions to “UNITED CEREBRAL PALSY OF TAMPA BAY, INC ” Practice Location

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