| Community Health Center At St Petersburg | |
|
612 Dr Martin L King St N St Petersburg FL 33705 | |
| (727) 824-8181 | |
| Not Available |
| Full Name | Community Health Center At St Petersburg |
|---|---|
| Speciality | Clinic/Center |
| Location | 612 Dr Martin L King St N, St Petersburg, Florida |
| Authorized Official Name and Position | Edward Kucher (CHIEF REGULATORY OFFICER) |
| Authorized Official Contact | 7278248100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Health Center At St Petersburg Po Box 10549 St Petersburg FL 33733-0549 Ph: (727) 824-8181 | Community Health Center At St Petersburg 612 Dr Martin L King St N St Petersburg FL 33705 Ph: (727) 824-8181 |
| NPI Number | 1437550084 |
|---|---|
| Provider Enumeration Date | 09/12/2014 |
| Last Update Date | 10/17/2024 |
| Medicare PECOS PAC ID | 8527961028 |
|---|---|
| Medicare Enrollment ID | O20150204000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437550084 | NPI | - | NPPES |
| 029565521 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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