Provider Demographics
NPI:1447441449
Name:TAMPA BAY BRACE AND LIMB INC
Entity type:Organization
Organization Name:TAMPA BAY BRACE AND LIMB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-449-9292
Mailing Address - Street 1:516 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3302
Mailing Address - Country:US
Mailing Address - Phone:727-449-9292
Mailing Address - Fax:
Practice Address - Street 1:516 LAKEVIEW RD VILLA1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9999
Practice Address - Country:US
Practice Address - Phone:727-449-9292
Practice Address - Fax:727-449-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR161335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM0692OtherBLUE CROSS BLUE SHIELD
FL00124OtherUNIVERSAL HEALTH CARE
FL186747OtherWELLCARE
FL=========OtherHUMANA
FLM0692OtherBLUE CROSS BLUE SHIELD
FLM0692OtherBLUE CROSS BLUE SHIELD