Healthcare Provider Details

I. General information

NPI: 1740407121
Provider Name (Legal Business Name): ORTHOPAEDIC MEDICAL GROUP OF TAMPA BAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13837 CIRCA CROSSING DR
LITHIA FL
33547
US

IV. Provider business mailing address

PO BOX 850001 DEPT 8272
ORLANDO FL
32885-8272
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-441-7161
Mailing address:
  • Phone: 813-684-2663
  • Fax: 813-441-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SCOTT E GOLDSMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 813-684-2663