1427120351 NPI number — CLINICARE MEDICAL RESOURCES, INC.

Table of content: (NPI 1427120351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427120351 NPI number — CLINICARE MEDICAL RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICARE MEDICAL RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLINICARE HOME MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427120351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9245 LAZY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-1595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-935-1341
Provider Business Mailing Address Fax Number:
800-603-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 US HIGHWAY 98
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
EASTPOINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32328-3381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-674-5555
Provider Business Practice Location Address Fax Number:
850-674-5551
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-935-1341

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  031190100 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 945910098B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108078500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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