=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265419907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTEES OF MEASE HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3231 N MCMULLEN BOOTH RD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33761-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-725-6111
-----------------------------------------------------
Fax | 727-725-6181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3231 N MCMULLEN BOOTH RD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33761-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-281-9479
-----------------------------------------------------
Fax | 727-725-6181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. CARL TREMONTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-462-7176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 4378
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------