Healthcare Provider Details

I. General information

NPI: 1386961068
Provider Name (Legal Business Name): MID PINELLAS PRIMARY CARE, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13787 BELCHER RD S SUITE 100
LARGO FL
33771-4065
US

IV. Provider business mailing address

13787 BELCHER RD S SUITE 100
LARGO FL
33771-4065
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-9899
  • Fax: 727-535-2818
Mailing address:
  • Phone: 727-535-9899
  • Fax: 727-535-2818

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: DR. JASON H HOWARD
Title or Position: MGRM
Credential: DO
Phone: 727-535-9899