Provider Demographics
NPI:1144924754
Name:NORTH TAMPA EXECUTIVE HEALTH, PLLC
Entity type:Organization
Organization Name:NORTH TAMPA EXECUTIVE HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEACHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-997-7942
Mailing Address - Street 1:1204 S BROAD ST # 192
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3132
Mailing Address - Country:US
Mailing Address - Phone:352-410-2595
Mailing Address - Fax:
Practice Address - Street 1:3500 E FLETCHER AVE STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4795
Practice Address - Country:US
Practice Address - Phone:813-753-8836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health