MEDICARE: CLEARALL AIT

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
1	363LF0000X	Family Nurse Practitioner
2	207KA0200X	Allergy Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619613890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARALL AIT

Provider Business Mailing Address
First Line	:	PO BOX 46
Second Line	:
City	:	TERRA CEIA
State	:	FL
Zip	:	34250-0046
Country	:	US
Telephone Number	:	667-930-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 RITCHIE HWY STE A
Second Line	:
City	:	BROOKLYN PARK
State	:	MD
Zip	:	21225-3069
Country	:	US
Telephone Number	:	667-930-5999
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	MR. ROBERT WILLIAM JACOBS JR.
Credential	:
Telephone Number	:	703-627-0879

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	10/28/2022

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