Provider Demographics
NPI:1407186463
Name:MEDI-CLINIC SARASOTA INC.
Entity type:Organization
Organization Name:MEDI-CLINIC SARASOTA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-966-7640
Mailing Address - Street 1:2107 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9668
Mailing Address - Country:US
Mailing Address - Phone:941-966-7640
Mailing Address - Fax:941-966-7641
Practice Address - Street 1:2107 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9668
Practice Address - Country:US
Practice Address - Phone:941-966-7640
Practice Address - Fax:941-966-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24212261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02404BMedicare Oscar/Certification
FLD13879Medicare UPIN