Provider Demographics
NPI:1790774693
Name:PRICE HOFFMAN STONE & ASSOCIATES MDS PA
Entity Type:Organization
Organization Name:PRICE HOFFMAN STONE & ASSOCIATES MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-898-3647
Mailing Address - Street 1:DEPT AT 952404
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31192-0001
Mailing Address - Country:US
Mailing Address - Phone:727-898-3647
Mailing Address - Fax:727-823-3080
Practice Address - Street 1:747 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4509
Practice Address - Country:US
Practice Address - Phone:727-898-3647
Practice Address - Fax:727-823-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044931800Medicaid
FLV2869OtherBCBS PROVIDER #
FLV2869OtherBCBS PROVIDER #