Provider Demographics
NPI:1134961287
Name:CLOW INTEGRATED MEDICAL CENTER PA
Entity type:Organization
Organization Name:CLOW INTEGRATED MEDICAL CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT SEVICES
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-725-8778
Mailing Address - Street 1:145 PALM BAY RD NE STE 120
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8601
Mailing Address - Country:US
Mailing Address - Phone:321-725-8778
Mailing Address - Fax:321-984-5299
Practice Address - Street 1:145 PALM BAY RD NE STE 121
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8601
Practice Address - Country:US
Practice Address - Phone:321-725-8778
Practice Address - Fax:321-984-5299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPACE COAST CORPORATE HEALTH SERVICE P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-10
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty