Provider Demographics
NPI:1265988752
Name:VERIMED HEALTH GROUP CLEARWATER, LLC
Entity type:Organization
Organization Name:VERIMED HEALTH GROUP CLEARWATER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-8600
Mailing Address - Street 1:2515 COUNTRYSIDE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1603
Mailing Address - Country:US
Mailing Address - Phone:727-796-8600
Mailing Address - Fax:813-932-0266
Practice Address - Street 1:2515 COUNTRYSIDE BLVD STE H
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1603
Practice Address - Country:US
Practice Address - Phone:727-796-8600
Practice Address - Fax:813-932-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty