Provider Demographics
NPI:1033744818
Name:ST. PETERSBURG SURGICAL SPECIALIST
Entity Type:Organization
Organization Name:ST. PETERSBURG SURGICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESTERVELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-580-0336
Mailing Address - Street 1:5830 LEELAND ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1634
Mailing Address - Country:US
Mailing Address - Phone:727-580-0336
Mailing Address - Fax:
Practice Address - Street 1:601 7TH ST S STE 495
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4746
Practice Address - Country:US
Practice Address - Phone:727-580-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty