Healthcare Provider Details

I. General information

NPI: 1922446947
Provider Name (Legal Business Name): ALLCARE CLINICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89C HOSPITAL DRIVE
BREVARD NC
28712
US

IV. Provider business mailing address

4919 MEMORIAL HWY STE 200
TAMPA FL
33634-7500
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-3477
  • Fax: 828-274-7407
Mailing address:
  • Phone: 866-631-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5924