1487660247 NPI number — SAINT PETERSBURG NEUROLOGY CLINIC

Table of content: (NPI 1487660247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487660247 NPI number — SAINT PETERSBURG NEUROLOGY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT PETERSBURG NEUROLOGY CLINIC
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:
1487660247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1099 5TH AVE N
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33705-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-820-7701
Provider Business Mailing Address Fax Number:
727-820-7700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SAINT PETERSBURG NEUROLOGY CLINIC
Provider Second Line Business Practice Location Address:
1099 5TH AVE. N. STE 300
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33705-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-820-7701
Provider Business Practice Location Address Fax Number:
727-820-7700
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
727-820-7701

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45463 . This is a "MEDICARE ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 274770700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33705A001 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2011453 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 45463 . This is a "BSBC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CH3830 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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