Healthcare Provider Details

I. General information

NPI: 1902944747
Provider Name (Legal Business Name): FLORIDA FAMILY RURAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 HARTFORD DR
AVON PARK FL
33825-9523
US

IV. Provider business mailing address

2398 HARTFORD DR
AVON PARK FL
33825-9523
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-2500
  • Fax: 863-453-0745
Mailing address:
  • Phone: 863-453-2500
  • Fax: 863-453-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPA1725
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME 91882
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL RAY KARR
Title or Position: PRESIDENT
Credential: P.A.-C
Phone: 863-453-2500