MEDICARE: TESLA MEDICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1801399878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TESLA MEDICAL LLC

Provider Business Mailing Address
First Line	:	8401 BENJAMIN RD STE C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1203
Country	:	US
Telephone Number	:	727-420-4470
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 BENJAMIN RD STE C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1203
Country	:	US
Telephone Number	:	727-420-4470
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID PHILION
Credential	:
Telephone Number	:	727-420-4470

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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