Provider Demographics
NPI:1639229842
Name:PINELLAS PRIMARY CARE INC
Entity Type:Organization
Organization Name:PINELLAS PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYSUKHLAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:PANARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-323-9000
Mailing Address - Street 1:2299 9TH AVE NORTH
Mailing Address - Street 2:STE 1F
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6851
Mailing Address - Country:US
Mailing Address - Phone:727-323-9000
Mailing Address - Fax:727-323-9100
Practice Address - Street 1:2299 9TH AVE NORTH
Practice Address - Street 2:STE 1F
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6851
Practice Address - Country:US
Practice Address - Phone:727-323-9000
Practice Address - Fax:727-323-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269655000Medicaid
FL269655000Medicaid