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647 34th Ave S St Petersburg FL 33705-3730 | |
| (727) 821-4819 | |
| (727) 822-6240 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 647 34th Ave S, St Petersburg, Florida |
| Authorized Official Name and Position | Gary Macmath (CEO/PRESIDENT) |
| Authorized Official Contact | 7278214819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
445 31st Street North St. Petersburg FL 33713-7605 Ph: (727) 821-4819 | 647 34th Ave S St Petersburg FL 33705-3730 Ph: (727) 821-4819 |
| NPI Number | 1194838839 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0749475994 |
|---|---|
| Medicare Enrollment ID | O20101112000826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194838839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Randolph Heinrich Hemsath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700926391 PECOS PAC ID: 3577473842 Enrollment ID: I20090526000367 |
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