Provider Demographics
NPI:1568426682
Name:PINELLAS UROLOGY, INC.
Entity Type:Organization
Organization Name:PINELLAS UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-381-8667
Mailing Address - Street 1:5747 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1925
Mailing Address - Country:US
Mailing Address - Phone:727-381-8667
Mailing Address - Fax:727-345-1951
Practice Address - Street 1:5747 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1925
Practice Address - Country:US
Practice Address - Phone:727-381-8667
Practice Address - Fax:727-345-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00413Medicare ID - Type Unspecified