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Organization
PCA MEDICAL GROUP, INC.
Active
Organization
PCA MEDICAL GROUP, INC.
Active
Other names
STARUS Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. C. ROSS BERRY MBA, CMPE, FAAMA (PRESIDENT & CEO)
(813) 440-4402
Entity
Organization
Contact information
Practice address
34650 US 19 N, SUITE 104, PALM HARBOR, FL 34684-2155
(727) 789-2922
(727) 787-4288
Mailing address
1715 N WEST SHORE BLVD, SUITE 780, TAMPA, FL 33607-3932
(813) 440-4402
(813) 440-4407
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006386600
—
FL
05
—
006386601
—
FL
05
—
006386602
—
FL
05
—
006386603
—
FL
05
—
006386604
—
FL
05
—
006386605
—
FL
05
—
006386606
—
FL
05
—
006386607
—
FL
05
—
006386608
—
FL
Enumeration date
09/06/2007
Last updated
03/14/2016
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