Provider Demographics
NPI:1023210986
Name:NORTH FL ARTHRITIS CLINIC, PA.
Entity Type:Organization
Organization Name:NORTH FL ARTHRITIS CLINIC, PA.
Other - Org Name:NORTH FL ARTHRITIS CLINIC, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-719-6520
Mailing Address - Street 1:4551 W EST US 90
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055
Mailing Address - Country:US
Mailing Address - Phone:386-719-6520
Mailing Address - Fax:386-719-6592
Practice Address - Street 1:4551 W EST US 90
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-719-6520
Practice Address - Fax:386-719-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32116OtherBC/BS
FL32116OtherBC/BS
FLK3684Medicare PIN