Healthcare Provider Details

I. General information

NPI: 1255326302
Provider Name (Legal Business Name): RMG IVF/ SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 E FLETCHER AVE
TAMPA FL
33617-1126
US

IV. Provider business mailing address

5249 E FLETCHER AVE
TAMPA FL
33617-1126
US

V. Phone/Fax

Practice location:
  • Phone: 813-989-0120
  • Fax: 813-989-0268
Mailing address:
  • Phone: 813-989-0120
  • Fax: 813-989-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number1193
License Number StateFL

VIII. Authorized Official

Name: SAMUEL TARANTINO JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-989-0120