1255319976 NPI number — COMMUNITY HEALTH CENTER OF PINELLAS INC

Table of content: (NPI 1255319976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255319976 NPI number — COMMUNITY HEALTH CENTER OF PINELLAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTER OF PINELLAS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255319976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33733-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-824-8126
Provider Business Mailing Address Fax Number:
727-824-8166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12420 130TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-1950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-587-7729
Provider Business Practice Location Address Fax Number:
727-587-7739
Provider Enumeration Date:
01/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DORSO
Authorized Official First Name:
ELODIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
727-821-8100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 029565513 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 029565512 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".