Healthcare Provider Details

I. General information

NPI: 1780064808
Provider Name (Legal Business Name): RURAL HEALTH CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 PALM COAST PKWY SW SUITE 5
PALM COAST FL
32137-4785
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 386-246-3954
  • Fax: 386-246-3960
Mailing address:
  • Phone: 386-326-7342
  • Fax: 386-325-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LAURA M. SPENCER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 386-328-0108