1770655607 NPI number — CLINICARE MEDICAL RESOURCES, INC.

Table of content: (NPI 1770655607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770655607 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:
1770655607
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:
813-935-8770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 US HIGHWAY 98
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
EASTPOINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32328-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-670-5555
Provider Business Practice Location Address Fax Number:
850-670-5559
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:  HME 1103 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: HME 1103 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: ORF 167 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 108079500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".