Healthcare Provider Details

I. General information

NPI: 1316913379
Provider Name (Legal Business Name): CMS GAINSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SW 16TH AVE
GAINESVILLE FL
32608
US

IV. Provider business mailing address

1701 SW 16TH AVE
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-1400
  • Fax: 352-334-1476
Mailing address:
  • Phone: 352-334-1400
  • Fax: 352-334-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. CATHY KEATHLEY
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 352-334-1394