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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
Authorized Official Information Name: WILLIAM WAYNE THARP
Title: ASSOC DEAN OF FINANCE
Phone: 352-265-8017
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
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other RR MEDICARE FL 690003337
MEDICAID FL 030048900
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 291U00000X - Clinical Medical Laboratory