1679520571 NPI number — COUNTY OF PINELLAS BOARD OF COUNTY COMMISSIONERS

Table of content: (NPI 1679520571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679520571 NPI number — COUNTY OF PINELLAS BOARD OF COUNTY COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF PINELLAS BOARD OF COUNTY COMMISSIONERS
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:
6
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:
1679520571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12490 ULMERTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33774-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-582-2000
Provider Business Mailing Address Fax Number:
727-582-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12490 ULMERTON RD
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:
33774-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-582-2000
Provider Business Practice Location Address Fax Number:
727-582-2021
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARE
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF EMS ADMINISTRATION
Authorized Official Telephone Number:
727-582-5752

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  002468 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0069063 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 087678000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0081-0000263 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9598934 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270850 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 31251 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 230268 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 087678000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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