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General NPI Number Information
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NPI Number | 1225027493
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Entity Type | Organization
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Legal Business Name | PROVIDENCE MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 3350 ULMERTON RD SUITE 16
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City | CLEARWATER
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State | FL
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Zip | 33762-3397
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Country | US
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Telephone | 727-540-9377
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Fax | 727-540-9387
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Provider Business Mailing Address
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Address Line | PO BOX 48833
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City | ST PETERSBURG
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State | FL
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Zip | 33743-8833
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Country | US
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Telephone | 727-540-9377
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Fax | 727-540-9387
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID RICHARD LEVERING JR.
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Credential |
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Telephone | 727-540-9377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 326
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License Number State | FL
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