Provider Demographics
NPI:1336172709
Name:DR. SEIFERT'S CLINIC, INC.
Entity Type:Organization
Organization Name:DR. SEIFERT'S CLINIC, INC.
Other - Org Name:SACRED HEART CLINIC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-212-5589
Mailing Address - Street 1:285 UPTOWN BLVD.
Mailing Address - Street 2:APT. 429
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5866
Mailing Address - Country:US
Mailing Address - Phone:407-212-5589
Mailing Address - Fax:800-234-0702
Practice Address - Street 1:393 CENTERPOINTE CIR
Practice Address - Street 2:SUITE 1483
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3453
Practice Address - Country:US
Practice Address - Phone:407-212-5589
Practice Address - Fax:800-234-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB0666AMedicare PIN