Provider Demographics
NPI:1972821700
Name:SEBRING MEDICAL GROUP PA
Entity Type:Organization
Organization Name:SEBRING MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTHERINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-386-9595
Mailing Address - Street 1:2237 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4936
Mailing Address - Country:US
Mailing Address - Phone:863-385-4300
Mailing Address - Fax:863-385-1463
Practice Address - Street 1:2237 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4936
Practice Address - Country:US
Practice Address - Phone:863-385-4300
Practice Address - Fax:863-385-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty