Provider Demographics
NPI:1609586098
Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF PINELLAS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF REGULATORY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-824-8100
Mailing Address - Street 1:14100 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-9900
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:
Practice Address - Street 1:1260 S MARTIN LUTHER KING JR AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4172
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:727-286-6224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF PINELLAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-28
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029565539Medicaid
FL029565541Medicaid