Ethos Health Tampa 1, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ETHOS HEALTH TAMPA 1, LLC

Practice address

4600 N Habana Ave Ste 25
Tampa, FL 33614-7123

Phone

(352) 732-5590

Fax

(352) 732-0292

NPI assigned

May 31, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Walker

Title

Owner/Operator

Phone

(352) 732-5590

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625616000000",
    "number": "1285126763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 SE 17TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344714607",
            "telephone_number": "352-732-5590",
            "fax_number": "352-732-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 N HABANA AVE STE 25",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147123",
            "telephone_number": "352-732-5590",
            "fax_number": "352-732-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHOS HEALTH TAMPA 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "352-732-5590"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Tampa, FL
• Providers in Tampa, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.