Healthcare Provider Details

I. General information

NPI: 1962192716
Provider Name (Legal Business Name): MEDWAY MEDICAL CENTERS OF CLEARWATER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 DRUID RD E
CLEARWATER FL
33756-5606
US

IV. Provider business mailing address

140 ISLAND WAY STE 115
CLEARWATER FL
33767-2216
US

V. Phone/Fax

Practice location:
  • Phone: 727-877-0004
  • Fax:
Mailing address:
  • Phone: 727-877-0004
  • Fax:

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK ACOSTA
Title or Position: PRESIDENT
Credential:
Phone: 727-877-0004