Provider Demographics
NPI:1790154714
Name:PINELLAS COUNTY PRIMARY CARE AND HOSPITALISTS PLLC
Entity Type:Organization
Organization Name:PINELLAS COUNTY PRIMARY CARE AND HOSPITALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-444-0407
Mailing Address - Street 1:1007 JEFFORDS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4082
Mailing Address - Country:US
Mailing Address - Phone:727-461-7908
Mailing Address - Fax:727-223-5269
Practice Address - Street 1:516 LAKEVIEW RD
Practice Address - Street 2:SUITE#4
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-461-7908
Practice Address - Fax:727-223-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015819900Medicaid
FLII685AMedicare PIN