Provider Demographics
NPI:1326518671
Name:CLI INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:CLI INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:JD, ESQUIRE
Authorized Official - Phone:813-489-9211
Mailing Address - Street 1:35190 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35190 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1929
Practice Address - Country:US
Practice Address - Phone:727-748-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1730325317Medicaid