Organization
WATERS EDGE MEDICAL CLINIC TAMPA LLC
Active
Organization
WATERS EDGE MEDICAL CLINIC TAMPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIDA VODOPALAS-PUODZIUNAS DC (OWNER)
(815) 603-9683
Entity
Organization
Contact information
Practice address
1700 66TH ST N STE 304, ST PETERSBURG, FL 33710-5500
(727) 550-0855
Mailing address
1700 66TH ST N STE 304, ST PETERSBURG, FL 33710-5500
(727) 550-0855
(727) 205-8159
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
05/16/2020
Last updated
08/23/2023
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