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NPI Code Detail

MEDICARE: TAMPA GENERAL MEDICAL GROUP INC

MEDICARE: TAMPA GENERAL MEDICAL GROUP 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
1261QU0200XUrgent Care Clinic/Center
2261Q00000XClinic/Center

General Provider Information

NPI Number : 1710692447
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAMPA GENERAL MEDICAL GROUP INC
Provider Business Mailing Address
First Line : PO BOX 1289
Second Line :
City : TAMPA
State : FL
Zip : 33601-1289
Country : US
Telephone Number : 855-844-8743
Fax Number : 813-844-5865
Provider Business Practice Location Address
First Line : 10740 PALM RIVER RD
Second Line :
City : TAMPA
State : FL
Zip : 33619-4573
Country : US
Telephone Number : 855-844-8743
Fax Number : 813-844-5865
Authorized Official
Title or Position : VP HEALTHCARE DESIGN
Name : PETER TRAVIS RIAD CHANG
Credential :
Telephone Number : 813-844-3956
Provider Enumeration Date : 01/17/2023
Last Update Date : 12/19/2025

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