Provider Demographics
NPI:1245285832
Name:SEBRING CLINIC
Entity type:Organization
Organization Name:SEBRING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-847-5618
Mailing Address - Street 1:16811 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6070
Mailing Address - Country:US
Mailing Address - Phone:512-847-5618
Mailing Address - Fax:
Practice Address - Street 1:16811 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6070
Practice Address - Country:US
Practice Address - Phone:512-847-5618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020BEMedicare PIN
TXF97095Medicare UPIN