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NPI Code Detail

MEDICARE: FLORIDA CLINICAL PRACTICE ASSOCIATION INC

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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1477201622
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 : 352-265-7922
Fax Number :
Provider Business Practice Location Address
First Line : 4197 NW 86TH TER FL 3
Second Line :
City : GAINESVILLE
State : FL
Zip : 32606-9278
Country : US
Telephone Number : 352-265-4357
Fax Number : 352-627-4161
Authorized Official
Title or Position : CEO
Name : MARVIN A. DEWAR
Credential : MD
Telephone Number : 352-265-8309
Provider Enumeration Date : 03/16/2022
Last Update Date : 03/23/2022

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Directions to “FLORIDA CLINICAL PRACTICE ASSOCIATION INC ” Practice Location

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