Organization
MJS IRRV COMPLEX TRUST
Active
Organization
MJS IRRV COMPLEX TRUST
Active
Other names
Fairmount Walk-in Med Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CIRILO M SERALDE JR. M.D. (OWNER/TRUSTEE)
(863) 382-4949
Entity
Organization
Contact information
Practice address
3750 US 27 N., SUITE 4-F, SEBRING, FL 33870-1690
(863) 382-4949
(863) 382-3811
Mailing address
3750 US 27 N., SUITE 4-F, SEBRING, FL 33870-1690
(863) 382-4949
(863) 382-3811
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME0043253
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0293128
CLIA GROUP NUMBER
—
01
—
21429
VICTOR M SERALDE MCR UPIN
FL
01
—
259715200
MEDIPASS PROVIDER NUMBER GROUP
FL
01
—
28115A
VICTOR SERALDE PROVIDER NUMBER FOR FAIRMOUNT CLINIC
FL
01
—
41214C
MEDICARE PROVIDER CIRILO SERALDE FOR FAIRMOUNT CLINIC
FL
01
—
54734
CIRILO M SERALDE MCR UPIN
FL
01
—
K2401
MEDICARE PART B GROUP PROVIDER
FL
Enumeration date
08/15/2007
Last updated
01/10/2013
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