Provider Demographics
NPI:1447926027
Name:CLEARWATER CARDIOVASCULAR AND INTERVENTIONAL CONSULTANTS MD PA
Entity type:Organization
Organization Name:CLEARWATER CARDIOVASCULAR AND INTERVENTIONAL CONSULTANTS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-445-1992
Mailing Address - Street 1:455 PINELLAS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3356
Mailing Address - Country:US
Mailing Address - Phone:727-445-1992
Mailing Address - Fax:
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 300
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-394-1911
Practice Address - Fax:727-394-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119872600Medicaid