MEDICARE: DR. CLYDE CALENSO VANTERPOOL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME67760	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114987641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLYDE CALENSO VANTERPOOL MD

Provider Business Mailing Address
First Line	:	PO BOX 9034
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-0134
Country	:	US
Telephone Number	:	863-835-2158
Fax Number	:	863-991-9060

Provider Business Practice Location Address
First Line	:	6801 US HIGHWAY 27 N STE C4
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1000
Country	:	US
Telephone Number	:	863-991-9060
Fax Number	:	863-991-9069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	01/21/2025

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