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General NPI Number Information
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NPI Number | 1073763470
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Entity Type | Organization
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Legal Business Name | SEBRING PSYCH MED INC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 1753 US 27 N
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City | AVON PARK
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State | FL
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Zip | 33825-9504
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Country | US
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Telephone | 863-452-1325
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Fax | 863-452-1385
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Provider Business Mailing Address
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Address Line | 1753 US 27 N
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City | AVON PARK
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State | FL
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Zip | 33825-9504
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Country | US
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Telephone | 863-452-1325
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Fax | 863-452-1385
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Authorized Official
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Title or Position | OWNER
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Name | MR. GERARDO F OLIVERA
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Credential | MD
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Telephone | 863-452-1325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 643642
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License Number State | FL
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