Provider Demographics
NPI:1467873315
Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-824-8100
Mailing Address - Street 1:PO BOX 10549
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0549
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:727-824-8150
Practice Address - Street 1:14100 58TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-9900
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:727-824-8150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF PINELLAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060638308Medicaid
FL060638309Medicaid