Provider Demographics
NPI:1679151708
Name:CASA CLINIC LLC
Entity Type:Organization
Organization Name:CASA CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-600-9981
Mailing Address - Street 1:3218 W HORATIO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3028
Mailing Address - Country:US
Mailing Address - Phone:813-600-9981
Mailing Address - Fax:
Practice Address - Street 1:13920 58TH ST N STE 1006
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3770
Practice Address - Country:US
Practice Address - Phone:813-600-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty