Basic Information
| Provider Information | |||||||||
| NPI: | 1881674851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USCG AIR STATION CLEARWATER CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15100 RESCUE WAY | ||||||||
| Address2: | USCG AIR STATION CLEARWATER CLINIC | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337623524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275351437 | ||||||||
| FaxNumber: | 7275354190 | ||||||||
| Practice Location | |||||||||
| Address1: | 15100 RESCUE WAY | ||||||||
| Address2: | USCG AIR STATION CLEARWATER CLINIC | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337623524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275351437 | ||||||||
| FaxNumber: | 7275354190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BELCHER | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF, HEALTH SERVICES DIVISION | ||||||||
| AuthorizedOfficialTelephone: | 7275351437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
No ID Information.