| St. Pete - Primary Care | |
|
560 Jackson St N Ste 302 St Petersburg FL 33705-1449 | |
| (727) 820-7701 | |
| Not Available |
| Full Name | St. Pete - Primary Care |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 560 Jackson St N Ste 302, St Petersburg, Florida |
| Authorized Official Name and Position | Lynda Gorken (VICE PRESIDENT) |
| Authorized Official Contact | 7272819390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Pete - Primary Care 2995 Drew St Fl 2 Clearwater FL 33759-3012 Ph: (727) 281-9390 | St. Pete - Primary Care 560 Jackson St N Ste 302 St Petersburg FL 33705-1449 Ph: (727) 820-7701 |
| NPI Number | 1114295680 |
|---|---|
| Provider Enumeration Date | 12/12/2011 |
| Last Update Date | 02/12/2020 |
| Certification Date | 02/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114295680 | NPI | - | NPPES |
| 060297319 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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