Organization
PROVIDENCE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RICHARD LEVERING JR. (PRESIDENT)
(727) 540-9377
Entity
Organization
Contact information
Practice address
3350 ULMERTON RD, SUITE 16, CLEARWATER, FL 33762-3397
(727) 540-9377
(727) 540-9387
Mailing address
PO BOX 48833, ST PETERSBURG, FL 33743-8833
(727) 540-9377
(727) 540-9387
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022415400
—
FL
01
—
R9114
BCBS OF FLORIDA
FL
Enumeration date
10/19/2005
Last updated
08/26/2014
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