Provider Demographics
NPI:1861976516
Name:FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Entity type:Organization
Organization Name:FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF FIN & ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBISKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-265-8017
Mailing Address - Street 1:PO BOX 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10435 SE 170TH PL
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8998
Practice Address - Country:US
Practice Address - Phone:352-259-5658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies