NPIMap

Organization Active NPI

Silver Wings Independence at Home LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Pinellas Park, FL
National Provider Identifier
1407128234
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
ME68819 Issued in FL
Legal business name
SILVER WINGS INDEPENDENCE AT HOME LLC
Practice address
6279 Park Blvd N
Pinellas Park, FL 33781-3239
Phone
(727) 548-1232
Fax
(727) 548-1182
NPI assigned
Feb 9, 2012
Last updated
Feb 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

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

Authorized official

Name
Laurence Milton Petty, M.D.
Title
Physician
Phone
(727) 548-1232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X ME68819 FL Primary

Addresses

Primary practice location

6279 Park Blvd N
Pinellas Park, FL 33781-3239

Mailing address

6279 Park Blvd N
Pinellas Park, FL 33781-3239
Phone (727) 548-1232

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1407128234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6279 PARK BLVD N",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813239",
            "telephone_number": "727-548-1232",
            "fax_number": "727-548-1182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6279 PARK BLVD N",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337813239",
            "telephone_number": "727-548-1232",
            "fax_number": "727-548-1182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER WINGS INDEPENDENCE AT HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "MILTON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "727-548-1232",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME68819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinellas Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.