Provider Demographics
NPI:1528239068
Name:MEDICAL ASSOCIATES OF CENTRAL PINELLAS
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF CENTRAL PINELLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEYTELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-344-7339
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE #350
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-344-7339
Mailing Address - Fax:727-343-8470
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE #350
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-344-7339
Practice Address - Fax:727-343-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044110261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069784200Medicaid
FL069784200Medicaid
FLCQ399AMedicare PIN