Provider Demographics
NPI:1427120351
Name:CLINICARE MEDICAL RESOURCES, INC.
Entity type:Organization
Organization Name:CLINICARE MEDICAL RESOURCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-1341
Mailing Address - Street 1:9245 LAZY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1595
Mailing Address - Country:US
Mailing Address - Phone:813-935-1341
Mailing Address - Fax:800-603-3939
Practice Address - Street 1:171 US HIGHWAY 98
Practice Address - Street 2:STE G
Practice Address - City:EASTPOINT
Practice Address - State:FL
Practice Address - Zip Code:32328-3381
Practice Address - Country:US
Practice Address - Phone:850-674-5555
Practice Address - Fax:850-674-5551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICARE MEDICAL RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL031190100332B00000X
FLORF 167335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA945910098BMedicaid
FL108078500Medicaid
FL1053910002Medicare NSC
TN4582329Medicaid
FL1053910002Medicare NSC
FL031190100Medicaid
MS00440834Medicaid
GA945910098BMedicaid