| Infectious Disease Consultants Of St. Petersburg, P.a. | |
|
4604 29th St E Palmetto FL 34221-9793 | |
| (941) 845-4572 | |
| (941) 845-4572 |
| Full Name | Infectious Disease Consultants Of St. Petersburg, P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4604 29th St E, Palmetto, Florida |
| Authorized Official Name and Position | Clinton Douglas Holder (OWNER) |
| Authorized Official Contact | 9418454572 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Consultants Of St. Petersburg, P.a. 4604 29th St E Palmetto FL 34221-9793 Ph: (941) 845-4572 | Infectious Disease Consultants Of St. Petersburg, P.a. 4604 29th St E Palmetto FL 34221-9793 Ph: (941) 845-4572 |
| NPI Number | 1982637195 |
|---|---|
| Provider Enumeration Date | 07/09/2006 |
| Last Update Date | 01/24/2014 |
| Medicare PECOS PAC ID | 7911927983 |
|---|---|
| Medicare Enrollment ID | O20051206000273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982637195 | NPI | - | NPPES |
| 5600211 | Other | GHI | |
| 34252 | Other | FL | BLUE CROSS/BLUE SHIELD FL |
| CB6866 | Other | RAILROAD MEDICARE | |
| 263649200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Clinton Douglas Holder |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1578560777 PECOS PAC ID: 1456371426 Enrollment ID: I20100818000653 |
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