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General NPI Number Information
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NPI Number | 1518396118
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Entity Type | Organization
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Legal Business Name | PREMIER ST. PETERSBURG
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 61 DOLPHIN DR
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City | TREASURE ISLAND
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State | FL
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Zip | 33706-3113
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Country | US
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Telephone | 513-300-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 61 DOLPHIN DR
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City | TREASURE ISLAND
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State | FL
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Zip | 33706-3113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CHRIS CARSON
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Credential |
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Telephone | 513-300-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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