Healthcare Provider Details

I. General information

NPI: 1366889040
Provider Name (Legal Business Name): NEW RIVER COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E MAIN ST
LAKE BUTLER FL
32054-1731
US

IV. Provider business mailing address

495 E MAIN ST
LAKE BUTLER FL
32054-1731
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-3211
  • Fax: 386-496-1599
Mailing address:
  • Phone: 386-496-3211
  • Fax: 386-496-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOE PIETRANGELO
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-964-7732