Waters Edge Medical Clinic Tampa LLC
NPI 1265054803ActiveOrganization· Clinic/Center, Multi-Specialty· St Petersburg, FL
Clinic/Center, Multi-Specialty in St Petersburg, Florida, registered in NPPES in May 2020. The authorized official on file is Vida Vodopalas-Puodziunas, DC, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1265054803 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 16, 2020 |
| Last updated in NPPES | Aug 23, 2023 |
| Certified by provider | Aug 23, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center, Multi-Specialty Primary | 261QM1300X | — | — |
| Clinic/Center, Primary Care | 261QP2300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
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