Healthcare Provider Details

I. General information

NPI: 1285983163
Provider Name (Legal Business Name): CRESCENT CIRCLE INPATIENT SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROSS CRESCENT CIR
FT OGLETHORPE GA
30742-3643
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N SUITE 650
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 706-585-2000
  • Fax:
Mailing address:
  • Phone: 727-437-3510
  • Fax: 727-536-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY J. BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2000