Organization
SQUARE 1 CLINICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAMBERT WAYNE LEROUX (CHAIRMAN)
(727) 480-4981
Entity
Organization
Contact information
Practice address
1212 COURT ST, CLEARWATER, FL 33756-5004
(727) 351-7239
Mailing address
1212 COURT ST, CLEARWATER, FL 33756-5004
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1062121-00
—
FL
Enumeration date
03/02/2020
Last updated
07/01/2021
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