Healthcare Provider Details

I. General information

NPI: 1629324751
Provider Name (Legal Business Name): RURAL HEALTH CARE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WHITEHALL DR SUITES 109-114
ST AUGUSTINE FL
32086-5269
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2782
  • Fax: 904-829-2494
Mailing address:
  • Phone: 386-328-0108
  • 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: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 386-328-0108