Provider Demographics
NPI:1104891936
Name:RUTH HANNO MD PA
Entity type:Organization
Organization Name:RUTH HANNO MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-978-8888
Mailing Address - Street 1:15310 AMBERLY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2199
Mailing Address - Country:US
Mailing Address - Phone:813-978-8888
Mailing Address - Fax:813-972-8974
Practice Address - Street 1:15310 AMBERLY DR
Practice Address - Street 2:SUITE 150
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2199
Practice Address - Country:US
Practice Address - Phone:813-978-8888
Practice Address - Fax:813-972-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7621ZOtherMEDICARE ID
FLU5804ZMedicare ID - Type Unspecified
FLK1148Medicare ID - Type Unspecified
FLU7621ZOtherMEDICARE ID
FLI39728Medicare UPIN
FLE5748ZMedicare ID - Type Unspecified
FLH40667Medicare UPIN
FL02757WMedicare ID - Type Unspecified
FLI148001Medicare UPIN