Provider Demographics
NPI:1093981599
Name:ST PETERSBURG FAMILY CARE CENTER
Entity Type:Organization
Organization Name:ST PETERSBURG FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-347-9000
Mailing Address - Street 1:7655 38TH AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1232
Mailing Address - Country:US
Mailing Address - Phone:727-347-9000
Mailing Address - Fax:
Practice Address - Street 1:7655 38TH AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1232
Practice Address - Country:US
Practice Address - Phone:727-347-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty