Healthcare Provider Details

I. General information

NPI: 1467873315
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF PINELLAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 58TH ST N STE 100
CLEARWATER FL
33760-9900
US

IV. Provider business mailing address

PO BOX 10549
ST PETERSBURG FL
33733-0549
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax: 727-824-8150
Mailing address:
  • Phone: 727-824-8181
  • Fax: 727-824-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: EDWARD KUCHER
Title or Position: CHIEF REGULATORY OFFICER
Credential:
Phone: 727-824-8100