Provider Demographics
NPI:1609950674
Name:USCG AIR STATION CLEARWATER
Entity Type:Organization
Organization Name:USCG AIR STATION CLEARWATER
Other - Org Name:USCG AIRSTATION CLEARWATER HEALTH SERVICES DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CHIEF WARRANT OFFICE
Authorized Official - Phone:727-535-1437
Mailing Address - Street 1:15100 RESCUE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15100 RESCUE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762
Practice Address - Country:US
Practice Address - Phone:727-535-1437
Practice Address - Fax:727-535-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service