Provider Demographics
NPI:1831165414
Name:INTERNATIONAL HEALTH CLINIC
Entity type:Organization
Organization Name:INTERNATIONAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIU
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:727-507-8555
Mailing Address - Street 1:13501 ICOT BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3729
Mailing Address - Country:US
Mailing Address - Phone:727-507-8555
Mailing Address - Fax:727-532-0091
Practice Address - Street 1:13501 ICOT BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3729
Practice Address - Country:US
Practice Address - Phone:727-507-8555
Practice Address - Fax:727-532-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68820261QP2300X
FLAP363171100000X
FLPT15201261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887272400Medicaid
FLC0198OtherBCBS ACUPUNCTURE #
FLF68019Medicare ID - Type UnspecifiedM.D
FLY6405Medicare ID - Type UnspecifiedPHYSICAL THERAPIST