MEDICARE: FLORIDA CLINICAL PRACTICE ASSOCIATION INC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1811241870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA CLINICAL PRACTICE ASSOCIATION INC

Provider Business Mailing Address
First Line	:	PO BOX 13833
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-3833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4037 NW 86TH TERR
Second Line	:	FIRST FLOOR
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-0000
Country	:	US
Telephone Number	:	352-265-6200
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	WILLIAM W THARP
Credential	:
Telephone Number	:	352-265-8017

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	12/28/2015

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