Mjs Irrv Complex Trust
May also be knows as Fairmount Walk-in Med Clinic
Clinic/Center in Sebring, FL(View on Map)
Legal Business Name
Mjs Irrv Complex Trust
Also Known As
Fairmount Walk-in Med Clinic
NPI Number
1588856306
NPI Type
Organization
Enumeration Date
08/15/2007
Specialties
(Taxonomies)Licenses
State
Florida
License Number
ME0043253
Contact
Information
Purpose
Mailing
Location
Address
3750 US 27 N.
3750 US 27 N.
City
Sebring
Sebring
State
FL
FL
Postal Code
33870-1690
33870-1690
Country
US
US
Telephone Number
(863) 382-4949
(863) 382-4949
Authorized Official
Name
Dr. Cirilo Seralde
Title or Position
OWNER/TRUSTEE
Telephone Number
(863) 382-4949
Identifiers
Identifier
21429
41214C
K2401
28115A
10D0293128
54734
259715200
Identifier State
FL
FL
FL
FL
Unknown
FL
FL
Identifier Issuer
VICTOR M SERALDE MCR UPIN
MEDICARE PROVIDER CIRILO SERALDE FOR FAIRMOUNT CLINIC
MEDICARE PART B GROUP PROVIDER
VICTOR SERALDE PROVIDER NUMBER FOR FAIRMOUNT CLINIC
CLIA GROUP NUMBER
CIRILO M SERALDE MCR UPIN
MEDIPASS PROVIDER NUMBER GROUP
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 01/10/2013
Provider Address
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