Organization
COUNTRYSIDE BIRTHING PLACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY J TREGILLUS LM (OWNER/OPERATOR)
(727) 796-7502
Entity
Organization
Contact information
Practice address
3060 JONES LN, CLEARWATER, FL 33759-1603
(727) 796-7502
(727) 796-7072
Mailing address
3060 JONES LN, CLEARWATER, FL 33759-1603
(727) 796-7502
(727) 796-7072
Taxonomy
Speciality
Code
Description
License number
State
261QB0400X
Birthing Clinic/Center
Primary
337
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011140400
—
FL
Enumeration date
08/22/2006
Last updated
07/29/2014
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