| John B. Decosmo,iii, D.o., P.a. | |
|
4800 4th St N St Petersburg FL 33703-3817 | |
| (727) 498-6488 | |
| (727) 362-6772 |
| Full Name | John B. Decosmo,iii, D.o., P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4800 4th St N, St Petersburg, Florida |
| Authorized Official Name and Position | John B Decosmo (PRESIDENT) |
| Authorized Official Contact | 7274986488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John B. Decosmo,iii, D.o., P.a. 4800 4th St N St Petersburg FL 33703-3817 Ph: (727) 498-6488 | John B. Decosmo,iii, D.o., P.a. 4800 4th St N St Petersburg FL 33703-3817 Ph: (727) 498-6488 |
| NPI Number | 1831474303 |
|---|---|
| Provider Enumeration Date | 10/17/2011 |
| Last Update Date | 04/12/2015 |
| Medicare PECOS PAC ID | 9234302167 |
|---|---|
| Medicare Enrollment ID | O20111109000322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831474303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | OS5534 (Florida) | Primary |
| Provider Name | John Battista Decosmo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396721221 PECOS PAC ID: 8628102423 Enrollment ID: I20100816000738 |
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