MEDICAL HOME PL
Ambulatory Health at 4 St, Saint Petersburg, FL

License number
Florida ME102187
Category
Ambulatory Health
Type
Primary Care
Owner
Name: MR. FRED ELTON CLARK III M.D.
Title: OWNER
Phone: (727) 525-4401
Address
Address
4401 4Th St N, Saint Petersburg, FL 33703
National Provider ID: 1629485271
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about MEDICAL HOME PL at bizstanding.com

Medical Home, Pl

Zephyrhills, FL  -  Saint Petersburg, FL

Status:
Inactive
Industry:
Health and Allied Services, Nec, Nsk, Health/Allied Services
Registration:
Oct 7, 2010
Addresses:
27030 Bentley Way, Zephyrhills, FL 33544
5199 6 St N, Saint Petersburg, FL 33703
PO Box 7651, Saint Petersburg, FL 33734
State ID:
L10000105361
Business type:
Florida Limited Liability
Managers:
Fred E. Clark Manager, inactive,Hui-Ping Wang Manager, inactive
Agent:
Gary M. Berkson

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