Healthcare Provider Details

I. General information

NPI: 1073763470
Provider Name (Legal Business Name): SEBRING PSYCH MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 US 27 N
AVON PARK FL
33825-9504
US

IV. Provider business mailing address

1753 US 27 N
AVON PARK FL
33825-9504
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-1325
  • Fax: 863-452-1385
Mailing address:
  • Phone: 863-452-1325
  • Fax: 863-452-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number643642
License Number StateFL

VIII. Authorized Official

Name: MR. GERARDO F OLIVERA
Title or Position: OWNER
Credential: MD
Phone: 863-452-1325