Provider Demographics
NPI:1679519243
Name:TAMPA BAY ARTIFICIAL LIMBS, INC.
Entity type:Organization
Organization Name:TAMPA BAY ARTIFICIAL LIMBS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:813-801-9110
Mailing Address - Street 1:5109 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1405
Mailing Address - Country:US
Mailing Address - Phone:813-801-9110
Mailing Address - Fax:813-801-9048
Practice Address - Street 1:5109 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1405
Practice Address - Country:US
Practice Address - Phone:813-801-9110
Practice Address - Fax:813-801-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO 25335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290808OtherSTAYWELL
FLR9100OtherBLUE CROSS BLUE SHIELD FL
FL120716100Medicaid
FL7376145OtherAETNA EPDB PIN #
FLV516P-7063OtherTAMPA VA VENDOR #
FLR9100OtherBLUE CROSS BLUE SHIELD FL
FL1285530001Medicare NSC