MEDICARE: TAMPA BAY SERVICES GROUP LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1073261913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY SERVICES GROUP LLC

Provider Business Mailing Address
First Line	:	8313 W HILLSBOROUGH AVE STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3819
Country	:	US
Telephone Number	:	813-382-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	8313 W HILLSBOROUGH AVE STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3819
Country	:	US
Telephone Number	:	813-382-1172
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISMARY PADRON
Credential	:
Telephone Number	:	813-568-1060

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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