MEDICARE: TAMPA ORTHOTIC MANAGEMENT SERVICES, INC

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	335E00000X	Prosthetic/Orthotic Supplier	ORT19	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	474446	OTHER	FL	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1065307	OTHER	FL	CAREPLUS
4	613214800	OTHER	FL	OWCP DEPARTMNT OF LABOR
5	TAMP3870-0	OTHER	FL	CIGNA
6	M2843	OTHER	FL	BLUE CROSS BLUE SHIELD
7	14445	OTHER	FL	UNIVERSAL

General Provider Information

NPI Number	:	1093993362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA ORTHOTIC MANAGEMENT SERVICES, INC

Provider Business Mailing Address
First Line	:	5537 SHELDON RD
Second Line	:	SUITE N
City	:	TAMPA
State	:	FL
Zip	:	33615-3167
Country	:	US
Telephone Number	:	813-886-9202
Fax Number	:	813-886-9223

Provider Business Practice Location Address
First Line	:	5537 SHELDON RD
Second Line	:	SUITE N
City	:	TAMPA
State	:	FL
Zip	:	33615-3167
Country	:	US
Telephone Number	:	813-886-9202
Fax Number	:	813-886-9223

Authorized Official
Title or Position	:	CERTIFIED ORTHOTIST/PRESIDENT
Name	:	MR. THOMAS HURLEY ECKERSON
Credential	:	CO, BOC, ABC
Telephone Number	:	813-886-9202

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/03/2009

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