Provider Demographics
NPI:1033781000
Name:SQUARE 1 CLINICS, INC
Entity Type:Organization
Organization Name:SQUARE 1 CLINICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARIMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-480-4981
Mailing Address - Street 1:1212 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5004
Mailing Address - Country:US
Mailing Address - Phone:727-295-1000
Mailing Address - Fax:
Practice Address - Street 1:1022 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4353
Practice Address - Country:US
Practice Address - Phone:727-295-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder