Organization
CLEARWATER EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
300 PINELLAS ST, CLEARWATER, FL 33756-3804
(727) 461-8552
Mailing address
PO BOX 7479, PHILADELPHIA, PA 19101-7479
(800) 355-0808
(610) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38109
BLUE SHIELD
FL
Enumeration date
07/17/2007
Last updated
07/17/2007
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