Provider Demographics
NPI:1194157032
Name:SPECTRA HEALTHCARE ASSOCIATES PA
Entity type:Organization
Organization Name:SPECTRA HEALTHCARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFF KOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-353-0911
Mailing Address - Street 1:509 S ARMENIA AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3395
Mailing Address - Country:US
Mailing Address - Phone:813-353-0911
Mailing Address - Fax:813-353-0914
Practice Address - Street 1:509 S ARMENIA AVE
Practice Address - Street 2:STE 302
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3395
Practice Address - Country:US
Practice Address - Phone:813-353-0911
Practice Address - Fax:813-353-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty