MEDICARE: HILLSBOROUGH MEDICAL ASSOCIATES 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	207R00000X	Internal Medicine Physician	ME47065	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33864	OTHER	FL	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568621019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSBOROUGH MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	7519 PAULA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4113
Country	:	US
Telephone Number	:	813-884-1478
Fax Number	:	813-884-1798

Provider Business Practice Location Address
First Line	:	7519 PAULA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4113
Country	:	US
Telephone Number	:	813-884-1478
Fax Number	:	813-884-1798

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBBIE A THOMAS
Credential	:
Telephone Number	:	813-884-1478

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	03/24/2009

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