| Entity Name: | CLYDE C. VANTERPOOL, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 May 1995 (30 years ago) |
| Document Number: | P95000033679 |
| FEI/EIN Number | 650575323 |
| Address: | 6801 US hwy 27 north, SEBRING, FL, 33870, US |
| Mail Address: | PO BOX 9034, SEBRING, FL, 33872, 90 |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437516689 | 2016-01-19 | 2024-10-31 | PO BOX 9034, SEBRING, FL, 338720134, US | 6801 US HIGHWAY 27 N STE B4, SEBRING, FL, 338701000, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 863-991-9060 |
| Fax | 8639919069 |
Authorized person
| Name | CLYDE CALENSO VANTERPOOL |
| Role | MANAGER / OWNER |
| Phone | 8639919060 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME67760 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 377470800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Vanterpool Clyde | Agent | 829 MALL RING Rd, SEBRING, FL, 33870 |
| Name | Role | Address |
|---|---|---|
| VANTERPOOL CLYDE C | President | PO BOX 9034, SEBRING, FL, 33872 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-06-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REINSTATEMENT | 2012-05-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
