Provider Demographics
NPI:1205168846
Name:NEW BEGINNINGS MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:NEW BEGINNINGS MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-865-4166
Mailing Address - Street 1:6776 54TH AVE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1405
Mailing Address - Country:US
Mailing Address - Phone:727-865-4166
Mailing Address - Fax:727-865-4170
Practice Address - Street 1:6776 54TH AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1405
Practice Address - Country:US
Practice Address - Phone:727-865-4166
Practice Address - Fax:727-865-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization