Provider Demographics
NPI:1609818145
Name:CLINICARE CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CLINICARE CLINICAL SERVICES, INC.
Other - Org Name:CLINICARE DIAGNOSTIC MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-2904
Mailing Address - Street 1:PO BOX 16264
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6264
Mailing Address - Country:US
Mailing Address - Phone:727-796-2904
Mailing Address - Fax:727-796-2965
Practice Address - Street 1:2112 SUNNYDALE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1207
Practice Address - Country:US
Practice Address - Phone:727-796-2904
Practice Address - Fax:866-961-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8722OtherFLORIDA AHCA HEALTHCARE CLINIC LICENSE
FL0010YOtherFLORIDA BLUE CROSS