MEDICARE: CARDIOTHORACIC SURGERY OF HYDE PARK INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RI0011X	Interventional Cardiology Physician
2	207R00000X	Internal Medicine Physician
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
4	207RC0000X	Cardiovascular Disease Physician
5	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093024333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOTHORACIC SURGERY OF HYDE PARK INC

Provider Business Mailing Address
First Line	:	301 W PLATT ST
Second Line	:	SUITE 24
City	:	TAMPA
State	:	FL
Zip	:	33606-2292
Country	:	US
Telephone Number	:	727-498-8898
Fax Number	:	727-800-6959

Provider Business Practice Location Address
First Line	:	8950 9TH ST N STE 102
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-3001
Country	:	US
Telephone Number	:	727-498-8898
Fax Number	:	727-800-6959

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	LEAH TEEKELL-TAYLOR
Credential	:
Telephone Number	:	727-498-8898

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	03/08/2021

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Directions to “CARDIOTHORACIC SURGERY OF HYDE PARK INC ” Practice Location

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