# GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1225601560
- **Legal business name:** GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
- **Authorized official:** WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
- **Authorized official phone:** (615) 372-3375

## Contact information

- **Practice address:** 2010 59TH ST W STE 1500, BRADENTON, FL 34209-4649
- **Practice address phone:** (941) 896-4788
- **Mailing address:** 2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
- **Mailing address phone:** (615) 372-5426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/23/2021
- **Last updated:** 07/23/2021