Provider Demographics
NPI:1194038307
Name:DSS CAPITAL LLC
Entity Type:Organization
Organization Name:DSS CAPITAL LLC
Other - Org Name:WINTER HAVEN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-516-1699
Mailing Address - Street 1:4290 S HWY 27
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8066
Mailing Address - Country:US
Mailing Address - Phone:352-536-9270
Mailing Address - Fax:352-536-9279
Practice Address - Street 1:1450 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4505
Practice Address - Country:US
Practice Address - Phone:863-299-1485
Practice Address - Fax:863-291-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty