Provider Demographics
NPI:1891260949
Name:WHITE CRANE CLINIC INC
Entity Type:Organization
Organization Name:WHITE CRANE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:727-942-4249
Mailing Address - Street 1:114 E TARPON AVE # 2
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3452
Mailing Address - Country:US
Mailing Address - Phone:727-942-4249
Mailing Address - Fax:727-258-2558
Practice Address - Street 1:9 HIBISCUS ST STE 5
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3436
Practice Address - Country:US
Practice Address - Phone:727-942-4249
Practice Address - Fax:727-258-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center