Healthcare Provider Details

I. General information

NPI: 1720474075
Provider Name (Legal Business Name): DISTRICT CLINIC HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39200 HOOKER HWY STE 101
BELLE GLADE FL
33430-5368
US

IV. Provider business mailing address

1515 N FLAGLER DR STE 101
WEST PALM BEACH FL
33401-3429
US

V. Phone/Fax

Practice location:
  • Phone: 561-642-1000
  • Fax:
Mailing address:
  • Phone: 561-659-1270
  • Fax: 561-802-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateFL

VIII. Authorized Official

Name: DARCY DAVIS
Title or Position: CEO
Credential:
Phone: 561-804-5885