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NPI Code Detail

MEDICARE: PATIENT CONNECT HEALTHCARE CLINIC LLC

MEDICARE: PATIENT CONNECT HEALTHCARE CLINIC 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
1261Q00000XClinic/CenterLC9743FL

General Provider Information

NPI Number : 1104106525
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATIENT CONNECT HEALTHCARE CLINIC LLC
Provider Business Mailing Address
First Line : 6350 CENTRAL AVE
Second Line : SUITE A
City : ST PETERSBURG
State : FL
Zip : 33707-1430
Country : US
Telephone Number : 727-490-6326
Fax Number :
Provider Business Practice Location Address
First Line : 6350 CENTRAL AVE
Second Line : SUITE A
City : ST PETERSBURG
State : FL
Zip : 33707-1430
Country : US
Telephone Number : 727-490-6326
Fax Number :
Authorized Official
Title or Position : FINANCIAL OFFICER
Name : MRS. ANN L CONARD
Credential :
Telephone Number : 727-490-6326
Provider Enumeration Date : 08/17/2011
Last Update Date : 05/24/2012

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Directions to “PATIENT CONNECT HEALTHCARE CLINIC LLC ” Practice Location

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