MEDICARE: IBIS HEALTHCARE 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1124315296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBIS HEALTHCARE INC

Provider Business Mailing Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:	813-239-8069
Fax Number	:	813-272-3766

Provider Business Practice Location Address
First Line	:	2215 E HENRY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4460
Country	:	US
Telephone Number	:	813-239-8069
Fax Number	:	813-272-3766

Authorized Official
Title or Position	:	CEO
Name	:	ROAYA TYSON
Credential	:
Telephone Number	:	813-239-8088

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	03/27/2026

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