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Provider Information for 1326108903



FLORIDA CLINICAL PRACTICE ASSOCIATION INC

Organization Subpart: NO

Organization NPI: 1326108903

Calendar Last Updated: 2015-11-13

Details

Name Value
NPI 1326108903
Enumeration Date 2006-12-12
NPI Type 2- Organization
Status Active
Mailing Address PO BOX 13833
PHILADELPHIA, PA 19101-3833
United States

Phone: 352-265-7922 | Fax:
View Map External Link
Primary Practice Address 4800 SW 35TH DR
GAINESVILLE, FL 32608-7686
United States

Phone: 352-265-7922 | Fax:
View Map External Link
Authorized Official Information Name: WILLIAM WAYNE THARP
Title: ASSOC DEAN OF FINANCE
Phone: 352-265-8017
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 291U00000X - Clinical Medical Laboratory
Other Identifiers
Issuer State Number
Other RR MEDICARE FL 690003337
MEDICARE PIN FL L8486
MEDICAID FL 030048900