Provider Demographics
NPI:1609384700
Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Other - Org Name:COMMUNITY HEALTH CENTER AT LEALMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-824-8100
Mailing Address - Street 1:PO BOX 10549
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0549
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:
Practice Address - Street 1:4950 34TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-3031
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF PINELLAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029565525Medicaid