Providence Medical Corporation

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

326 Issued in FL

Legal business name

PROVIDENCE MEDICAL CORPORATION

Practice address

3350 Ulmerton Rd
Suite 16
Clearwater, FL 33762-3397

Phone

(727) 540-9377

Fax

(727) 540-9387

NPI assigned

Oct 19, 2005

Last updated

Aug 26, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David Richard Levering Jr.

Title

President

Phone

(727) 540-9377

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1225027493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48833",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337438833",
            "telephone_number": "727-540-9377",
            "fax_number": "727-540-9387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 ULMERTON RD",
            "address_2": "SUITE 16",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337623397",
            "telephone_number": "727-540-9377",
            "fax_number": "727-540-9387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "LEVERING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-540-9377",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "R9114",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022415400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; 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.