MEDICARE: COMMUNITY CARE MEDICAL CENTER, 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1558486696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	5500 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33703-1204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33703-1204
Country	:	US
Telephone Number	:	727-525-5500
Fax Number	:	727-522-2574

Authorized Official
Title or Position	:	MANAGER
Name	:	STEPHANIE BARBER
Credential	:
Telephone Number	:	727-525-5500

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/17/2008

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