Healthcare Provider Details

I. General information

NPI: 1124405022
Provider Name (Legal Business Name): SNC HOLDING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17805 N US HIGHWAY 301
CITRA FL
32113-2459
US

IV. Provider business mailing address

17805 N US HIGHWAY 301
CITRA FL
32113-2459
US

V. Phone/Fax

Practice location:
  • Phone: 352-595-7777
  • Fax: 352-595-4047
Mailing address:
  • Phone: 352-595-7777
  • Fax: 352-595-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK C SPOGEN III
Title or Position: CEO
Credential: RPHCP
Phone: 352-572-0666