Provider Demographics
NPI:1629029897
Name:ST ANTHONY'S PRIMARY CARE LLC
Entity Type:Organization
Organization Name:ST ANTHONY'S PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-532-1355
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1830
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:300 PARK PLACE BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4932
Practice Address - Country:US
Practice Address - Phone:727-532-1355
Practice Address - Fax:727-266-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE6358OtherRAILROAD MEDICARE NUMBER
FL276113100Medicaid
FLK9536Medicare PIN