Provider Demographics
NPI:1447345541
Name:CLEARWATER HEMATOLOGY ONCOLOGY ASSOC PA
Entity type:Organization
Organization Name:CLEARWATER HEMATOLOGY ONCOLOGY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HITESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-447-8100
Mailing Address - Street 1:303 PINELLAS ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3809
Mailing Address - Country:US
Mailing Address - Phone:727-447-8100
Mailing Address - Fax:727-461-2603
Practice Address - Street 1:303 PINELLAS STREET
Practice Address - Street 2:SUITE 330
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3809
Practice Address - Country:US
Practice Address - Phone:727-447-8100
Practice Address - Fax:727-461-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59034174400000X
FLARNP 1435602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376230100Medicaid
FL255143800Medicaid
FLCN7269OtherRR MEDICARE
FLCN7269OtherRR MEDICARE
FL33119Medicare PIN