Provider Demographics
NPI:1962452151
Name:SOUTHEAST REGIONAL ARTHRITIS CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEAST REGIONAL ARTHRITIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-447-3434
Mailing Address - Street 1:PO BOX 5227
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-5227
Mailing Address - Country:US
Mailing Address - Phone:727-447-3434
Mailing Address - Fax:727-447-6969
Practice Address - Street 1:2221 KENT PL
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6624
Practice Address - Country:US
Practice Address - Phone:727-447-3434
Practice Address - Fax:727-447-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033416200Medicaid
FLDE5891OtherRAILROAD MEDICARE
FL033416200Medicaid