Provider Demographics
NPI:1558907873
Name:USCG CLINIC ST PETERSBURG
Entity Type:Organization
Organization Name:USCG CLINIC ST PETERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SYSTEMS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-628-4363
Mailing Address - Street 1:600 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5030
Mailing Address - Country:US
Mailing Address - Phone:727-535-1437
Mailing Address - Fax:
Practice Address - Street 1:600 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-5030
Practice Address - Country:US
Practice Address - Phone:727-535-1437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient