Provider Demographics
NPI:1932143385
Name:ST. ANTHONY'S SPECIALISTS LLC
Entity Type:Organization
Organization Name:ST. ANTHONY'S SPECIALISTS 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 1829
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1829
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:727-532-0002
Practice Address - Fax:727-266-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279784400Medicaid
DN0852OtherMEDICARE RAILROAD PROVIDER GROUP NUMBER
FL279784400Medicaid