Provider Demographics
NPI:1710260336
Name:ST PETERSBURG MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ST PETERSBURG MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-289-7139
Mailing Address - Street 1:335 31ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1419
Mailing Address - Country:US
Mailing Address - Phone:727-289-7139
Mailing Address - Fax:727-289-7140
Practice Address - Street 1:335 31ST SOUTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1419
Practice Address - Country:US
Practice Address - Phone:727-289-7139
Practice Address - Fax:727-289-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME926562085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty