Provider Demographics
NPI:1407120298
Name:NW TAMPA SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:NW TAMPA SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:AGUIAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-658-3600
Mailing Address - Street 1:12015 WHITMARSH LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1737
Mailing Address - Country:US
Mailing Address - Phone:813-658-3600
Mailing Address - Fax:813-739-0917
Practice Address - Street 1:12015 WHITMARSH LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1737
Practice Address - Country:US
Practice Address - Phone:813-658-3600
Practice Address - Fax:813-739-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82789261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7296502OtherAETNA
2002441OtherCCN FIRST HEALTH
FL01119OtherBCBS FL
FLG56457Medicare UPIN
FL01119OtherBCBS FL