=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134290679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES A HALEY VA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13000 BRUCE B DOWNS BLVD
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33612-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-972-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22520 EAGLES WATCH DR
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34639-6773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-469-1955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESP THERAPIST
-----------------------------------------------------
Name | MR. ELLIOT ECHEVARRIA
-----------------------------------------------------
Credential | RRT
-----------------------------------------------------
Telephone | 813-469-1955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2865M2000X
-----------------------------------------------------
Taxonomy Name | Military General Acute Care Hospital
-----------------------------------------------------
License Number | RT 3850
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------