Provider Demographics
NPI:1881031425
Name:CLEAR SCOPE HEALTHCARE LLC
Entity Type:Organization
Organization Name:CLEAR SCOPE HEALTHCARE LLC
Other - Org Name:PALMAS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:7756 PALM RIVER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4215
Practice Address - Country:US
Practice Address - Phone:813-626-0066
Practice Address - Fax:866-441-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHG661AMedicare PIN