Healthcare Provider Details

I. General information

NPI: 1609950674
Provider Name (Legal Business Name): USCG AIR STATION CLEARWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 RESCUE WAY
CLEARWATER FL
33762
US

IV. Provider business mailing address

15100 RESCUE WAY
CLEARWATER FL
33762
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM STANLEY PERRY
Title or Position: CLINIC ADMINISTRATOR
Credential: CHIEF WARRANT OFFICE
Phone: 727-535-1437