Provider Demographics
NPI:1003946591
Name:ST JOSEPH'S COMMUNITY CARE INC
Entity Type:Organization
Organization Name:ST JOSEPH'S COMMUNITY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-281-9202
Mailing Address - Street 1:3550 W WATERS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2767
Mailing Address - Country:US
Mailing Address - Phone:813-886-8899
Mailing Address - Fax:
Practice Address - Street 1:3550 W WATERS AVE STE 110
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2767
Practice Address - Country:US
Practice Address - Phone:813-886-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372550201Medicaid
FL3725502-00Medicaid
FL3725502-00Medicaid