Provider Demographics
NPI:1831579564
Name:CLEARWATER HEADACHE CENTER, LLC
Entity type:Organization
Organization Name:CLEARWATER HEADACHE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-441-2149
Mailing Address - Street 1:1289 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5807
Mailing Address - Country:US
Mailing Address - Phone:727-441-2149
Mailing Address - Fax:727-442-2532
Practice Address - Street 1:1289 COURT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5807
Practice Address - Country:US
Practice Address - Phone:727-441-2149
Practice Address - Fax:727-442-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center