Provider Demographics
NPI:1518911031
Name:GALEN OF FLORIDA, INC.
Entity Type:Organization
Organization Name:GALEN OF FLORIDA, INC.
Other - Org Name:HCA FLORIDA ST. PETERSBURG HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-341-4806
Mailing Address - Street 1:PO BOX 13096
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-3096
Mailing Address - Country:US
Mailing Address - Phone:727-384-1414
Mailing Address - Fax:727-341-4889
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-384-1414
Practice Address - Fax:727-341-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000030901OtherHUMANA
0473910OtherAETNA
MA1005006Medicaid
OH233161Medicaid
MI304862800Medicaid
FL012010300Medicaid
KY1167499OtherPASSPORT HEALTH
FL558OtherBLUE CROSS
SC122527Medicaid
MI404862810Medicaid
036994000OtherBLACK LUNG
GA21074OtherWELLCARE
SC363591Medicaid
GA483195329AMedicaid
21074OtherWELLCARE/STAYWELL
NY01754329Medicaid
ALSTP0180NMedicaid
2=========069OtherUNITED HEALTH CARE
036994000OtherBLACK LUNG