MEDICARE: TAMPA BAY IPA, 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1740623651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY IPA, INC

Provider Business Mailing Address
First Line	:	1508 SEAGULL DR
Second Line	:	UNIT 104
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2450
Country	:	US
Telephone Number	:	727-512-2699
Fax Number	:	888-983-6442

Provider Business Practice Location Address
First Line	:	1508 SEAGULL DR
Second Line	:	UNIT 104
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2450
Country	:	US
Telephone Number	:	727-512-2699
Fax Number	:	888-983-6442

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WARREN S FISHMAN
Credential	:
Telephone Number	:	727-512-2699

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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