MEDICARE: TAMPA TRAUMA MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HCC6118	FL

General Provider Information

NPI Number	:	1063550481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA TRAUMA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4602 N ARMENIA AVE
Second Line	:	SUITE D1
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:	813-870-1900
Fax Number	:	813-870-1988

Provider Business Practice Location Address
First Line	:	4602 N ARMENIA AVE
Second Line	:	SUITE D1
City	:	TAMPA
State	:	FL
Zip	:	33603-2626
Country	:	US
Telephone Number	:	813-870-1900
Fax Number	:	813-870-1988

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LUIS M AZAN
Credential	:	M.D.
Telephone Number	:	813-870-1900

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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