Provider Demographics
NPI:1265488217
Name:FAMILY MEDICAL CARE OF ST PETERSBURG
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE OF ST PETERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-525-0006
Mailing Address - Street 1:3745 33RD ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1556
Mailing Address - Country:US
Mailing Address - Phone:727-525-0006
Mailing Address - Fax:727-521-3694
Practice Address - Street 1:3745 33RD ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1556
Practice Address - Country:US
Practice Address - Phone:727-525-0006
Practice Address - Fax:727-521-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97179Medicare ID - Type Unspecified