NPIMap

Organization Active NPI

Millennium Medical Inc

Doing business as Millennium Medical

  • Family Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1023047107
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MILLENNIUM MEDICAL INC
Doing business as
Millennium Medical
Practice address
5088 66TH St N
St Petersburg, FL 33709-3120
Phone
(727) 541-2675
Fax
(727) 541-3956
NPI assigned
Jul 1, 2006
Last updated
Jul 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lynn S Shulman
Title
Practice Adminstrator
Phone
(727) 541-2675

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Chiropractor 111N00000X NU
Acupuncturist 171100000X NU
Family Medicine Physician 207Q00000X NU Primary
Physical Therapist 225100000X NU
Massage Therapist 225700000X NU

Addresses

Primary practice location

5088 66TH St N
St Petersburg, FL 33709-3120

Mailing address

5088 66TH St N
St Petersburg, FL 33709-3120
Phone (727) 541-2675

Other identifiers 1

IdentifierTypeStateIssuer
0493287 00MedicaidFL

Other names 1

  • Millennium Medical Doing business as

National Provider Directory

National Provider Directory

Locations

5088 66th St N
St Petersburg, FL 33709
Phone (727) 541-2675

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1023047107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5088 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337093120",
            "telephone_number": "727-541-2675",
            "fax_number": "727-541-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5088 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337093120",
            "telephone_number": "727-541-2675",
            "fax_number": "727-541-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "SHULMAN",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRACTICE ADMINSTRATOR",
        "authorized_official_telephone_number": "727-541-2675"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0493287 00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millennium Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.