Provider Demographics
NPI:1609529478
Name:FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Entity Type:Organization
Organization Name:FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-265-8309
Mailing Address - Street 1:PO BOX 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:352-265-7922
Mailing Address - Fax:
Practice Address - Street 1:4730 SW 49TH RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6262
Practice Address - Country:US
Practice Address - Phone:352-355-1282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies