Basic Information
| Provider Information | |||||||||
| NPI: | 1366401879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH PINELLAS INTERNAL MEDICINE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2626 TAMPA RD | ||||||||
| Address2: | SUITE #202 | ||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346843155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277815811 | ||||||||
| FaxNumber: | 7277815613 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 TAMPA RD | ||||||||
| Address2: | SUITE #202 | ||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346843155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277815811 | ||||||||
| FaxNumber: | 7277815613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GEARY | ||||||||
| AuthorizedOfficialFirstName: | YVONNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7277815811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207R00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34185 | 01 | FL | BCBS | OTHER |