Provider Demographics
NPI:1053076463
Name:USCG SECTOR ST PETERSBURG CLINIC
Entity type:Organization
Organization Name:USCG SECTOR ST PETERSBURG CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:600 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5030
Mailing Address - Country:US
Mailing Address - Phone:727-502-1586
Mailing Address - Fax:727-502-7593
Practice Address - Street 1:600 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-5030
Practice Address - Country:US
Practice Address - Phone:727-502-1586
Practice Address - Fax:727-502-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient