Provider Demographics
NPI:1477133866
Name:CLAR AND GRACE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CLAR AND GRACE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-546-2713
Mailing Address - Street 1:38439 5TH AVE # 174
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-4328
Mailing Address - Country:US
Mailing Address - Phone:813-546-2713
Mailing Address - Fax:
Practice Address - Street 1:38439 5TH AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3540
Practice Address - Country:US
Practice Address - Phone:813-546-2713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care