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General NPI Number Information
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NPI Number | 1144522988
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Entity Type | Organization
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Legal Business Name | WEST TAMPA MEDICAL GROUP,LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2601 N HIMES AVE
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City | TAMPA
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State | FL
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Zip | 33607-2112
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Country | US
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Telephone | 813-873-8071
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Fax | 813-877-4031
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Provider Business Mailing Address
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Address Line | 5901 WEBB RD
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City | TAMPA
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State | FL
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Zip | 33615-3219
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Country | US
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Telephone | 813-888-8215
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Fax | 813-885-5398
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | ANTONIO CALVO
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Credential |
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Telephone | 813-888-8215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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