Provider Demographics
NPI:1649605445
Name:ST JOSEPH HOSPITAL
Entity type:Organization
Organization Name:ST JOSEPH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAALER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-310-3757
Mailing Address - Street 1:308 N BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1408
Mailing Address - Country:US
Mailing Address - Phone:813-877-3357
Mailing Address - Fax:
Practice Address - Street 1:308 N BEVERLY AVE
Practice Address - Street 2:3001 MARTIN LUTHER KING JR. BLVD.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1408
Practice Address - Country:US
Practice Address - Phone:813-877-3357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000007014282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital