Provider Demographics
NPI:1538140967
Name:ST ANTHONY'S PROFESSIONAL BUILDINGS AND SERVICES, INC
Entity Type:Organization
Organization Name:ST ANTHONY'S PROFESSIONAL BUILDINGS AND SERVICES, INC
Other - Org Name:SA IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:
Authorized Official - Last Name:KYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-825-1074
Mailing Address - Street 1:P O BOX 403795
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:813-852-3272
Mailing Address - Fax:813-852-3233
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-556-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2607697-01Medicaid