Provider Demographics
NPI:1871647008
Name:SINCLAIR SURGICAL PA
Entity Type:Organization
Organization Name:SINCLAIR SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-4407
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-2507
Mailing Address - Country:US
Mailing Address - Phone:863-421-4407
Mailing Address - Fax:863-422-2888
Practice Address - Street 1:131 WEBB DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:863-421-4407
Practice Address - Fax:863-422-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88406208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL195424OtherAMERIGROUP
FL7127058OtherAETNA
FL2684284 00Medicaid
FL81652OtherBLUE CROSS BLUE SHIELD
FL81652ZMedicare ID - Type Unspecified
FL2684284 00Medicaid