Basic Information
| Provider Information | |||||||||
| NPI: | 1447345541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEARWATER HEMATOLOGY ONCOLOGY ASSOC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 PINELLAS ST | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274478100 | ||||||||
| FaxNumber: | 7274612603 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 PINELLAS STREET | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274478100 | ||||||||
| FaxNumber: | 7274612603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | HITESH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7274478100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP 1435602 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 174400000X | ME 59034 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 376230100 | 05 | FL | MEDICAID | 255143800 | 05 | FL | MEDICAID | CN7269 | 01 | FL | RR MEDICARE | OTHER |