Healthcare Provider Details

I. General information

NPI: 1306986393
Provider Name (Legal Business Name): USCG PERSONAL SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/18/2008
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN NORCOMA STEWARD
Title or Position: HS2
Credential:
Phone: 727-535-1437