| Greater Tampa Bay Physician Network, Llc | |
|
1615 Pasadena Ave S Ste 430 South Pasadena FL 33707-4521 | |
| (727) 397-0606 | |
| (727) 397-6161 |
| Full Name | Greater Tampa Bay Physician Network, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1615 Pasadena Ave S Ste 430, South Pasadena, Florida |
| Authorized Official Name and Position | William Tederick Johnson (GROUP VICE PRESIDENT/AO) |
| Authorized Official Contact | 6153723375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Tampa Bay Physician Network, Llc Po Box 742717 Atlanta GA 30374-2717 Ph: (615) 373-7600 | Greater Tampa Bay Physician Network, Llc 1615 Pasadena Ave S Ste 430 South Pasadena FL 33707-4521 Ph: (727) 397-0606 |
| NPI Number | 1649604364 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 10/15/2020 |
| Medicare PECOS PAC ID | 7416181920 |
|---|---|
| Medicare Enrollment ID | O20131015001919 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649604364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Secondary |
| Provider Name | William H Minnix |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386660496 PECOS PAC ID: 9133100332 Enrollment ID: I20040525000788 |
| Provider Name | Tim Carlson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649380478 PECOS PAC ID: 6901882927 Enrollment ID: I20040629000502 |
| Provider Name | Mihaela C Templer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497712947 PECOS PAC ID: 8527030998 Enrollment ID: I20040807000018 |
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