Healthcare Provider Details

I. General information

NPI: 1588709695
Provider Name (Legal Business Name): UNITED STATES COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TRANSOM CT
TAMPA FL
33607-5863
US

IV. Provider business mailing address

15100 RESCUE WAY
CLEARWATER FL
33762-2990
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD CHRISTOPHER WILSON
Title or Position: HEALTH SERVICE PETTY OFFICER
Credential:
Phone: 727-535-1437