Healthcare Provider Details

I. General information

NPI: 1629029897
Provider Name (Legal Business Name): ST ANTHONY'S PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARK PLACE BLVD SUITE 170
CLEARWATER FL
33759-4932
US

IV. Provider business mailing address

PO BOX 1830
CLEARWATER FL
33757-1830
US

V. Phone/Fax

Practice location:
  • Phone: 727-532-1355
  • Fax: 727-266-4928
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN L. CORRIGAN
Title or Position: CAO
Credential:
Phone: 727-532-1355