Provider Demographics
NPI: | 1174859052 |
---|---|
Name: | MEDICAL GROUP OF PINELLAS, PA |
Entity Type: | Organization |
Organization Name: | MEDICAL GROUP OF PINELLAS, PA |
Other - Org Name: | NORTHEAST PEDIATRICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BHUMI |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | UPADHYAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 727-526-7337 |
Mailing Address - Street 1: | 431 SOUTHWEST BLVD N |
Mailing Address - Street 2: | |
Mailing Address - City: | ST. PETERSBURG |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33703-6822 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 727-526-7337 |
Mailing Address - Fax: | 727-528-7337 |
Practice Address - Street 1: | 431 SOUTHWEST BLVD N |
Practice Address - Street 2: | |
Practice Address - City: | ST PETERSBURG |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33703-1399 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-526-7337 |
Practice Address - Fax: | 727-528-7337 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-10-27 |
Last Update Date: | 2016-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty |