Provider Demographics
NPI:1164836797
Name:PINELLAS HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:PINELLAS HEALTH & WELLNESS, LLC
Other - Org Name:ST. PETERSBURG HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:727-202-6807
Mailing Address - Street 1:222 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3314
Mailing Address - Country:US
Mailing Address - Phone:727-202-6807
Mailing Address - Fax:727-202-6896
Practice Address - Street 1:222 2ND ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3314
Practice Address - Country:US
Practice Address - Phone:727-202-6807
Practice Address - Fax:727-202-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty