Provider Demographics
NPI:1407698566
Name:TAMPA GENERAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:TAMPA GENERAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP CHIEF TRNSFRMTN OFCR FHSC
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TRAVIS RIAD
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-844-3956
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-3956
Mailing Address - Fax:
Practice Address - Street 1:19027 WINGSHOOTER WAY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558
Practice Address - Country:US
Practice Address - Phone:813-660-7900
Practice Address - Fax:813-821-9821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMPA GENERAL MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty