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General NPI Number Information
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NPI Number | 1659563971
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Entity Type | Organization
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Legal Business Name | CMS IRRV COMPLEX TRUST
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 343 S COMMERCE AVE
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City | SEBRING
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State | FL
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Zip | 33870-3607
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Country | US
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Telephone | 863-382-2772
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Fax | 863-382-3172
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Provider Business Mailing Address
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Address Line | 343 S COMMERCE AVE
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City | SEBRING
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State | FL
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Zip | 33870-3607
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Country | US
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Telephone | 863-382-2772
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Fax | 863-382-3172
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Authorized Official
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Title or Position | DIRECTOR/PHYSICIAN
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Name | DR. CIRILO M SERALDE JR.
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Credential | M.D.
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Telephone | 863-382-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME0043253
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License Number State | FL
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