Provider Demographics
NPI:1659563971
Name:CMS IRRV COMPLEX TRUST
Entity Type:Organization
Organization Name:CMS IRRV COMPLEX TRUST
Other - Org Name:SEBRING MEDICAL WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CIRILO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SERALDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-2772
Mailing Address - Street 1:343 S COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3607
Mailing Address - Country:US
Mailing Address - Phone:863-382-2772
Mailing Address - Fax:863-382-3172
Practice Address - Street 1:343 S COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3607
Practice Address - Country:US
Practice Address - Phone:863-382-2772
Practice Address - Fax:863-382-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043253261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259715200OtherMEDICAID GROUP MEDIPASS NUMBER
FLD21429OtherDR.VICTOR SERALDE-UPIN
FL41214ZOtherMEDICARE PROVIDER CIRILO SERALDE FOR SEBRING CLINIC
FLK2381OtherMEDICARE PTAN GROUP NUMBER
FLD54734OtherDR.CIRILO SERALDE,JR-UPIN
FL1659563971OtherNPI -GROUP
FLK2381OtherMEDICARE PTAN GROUP NUMBER