Provider Demographics
NPI:1518044288
Name:ST PETERSBURG EAR NOSE & THROAT CTR LLC
Entity Type:Organization
Organization Name:ST PETERSBURG EAR NOSE & THROAT CTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-321-3344
Mailing Address - Street 1:2299 9TH AVE N
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2299 9TH AVE N
Practice Address - Street 2:SUITE 3B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6800
Practice Address - Country:US
Practice Address - Phone:727-321-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90004207YP0228X, 207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Not Answered207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5545Medicare ID - Type UnspecifiedMEDICARE GROUP