Healthcare Provider Details

I. General information

NPI: 1326424565
Provider Name (Legal Business Name): ORTHOPAEDIC MEDICAL GROUP OF TAMPA BAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP SUITE 201
RIVERVIEW FL
33578-9498
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: 813-906-6100
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 State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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