MEDICARE: SA-PG PINELLAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1418095	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013913235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SA-PG PINELLAS, LLC

Provider Business Mailing Address
First Line	:	200 16TH AVE SE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-4400
Country	:	US
Telephone Number	:	727-585-9377
Fax Number	:	727-588-9038

Provider Business Practice Location Address
First Line	:	200 16TH AVE SE
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-4400
Country	:	US
Telephone Number	:	727-585-9377
Fax Number	:	727-588-9038

Authorized Official
Title or Position	:	CFO
Name	:	MR. BRUCE WERTHEIM
Credential	:
Telephone Number	:	914-390-4322

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/23/2008

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Directions to “SA-PG PINELLAS, LLC ” Practice Location

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