Healthcare Provider Details

I. General information

NPI: 1568712693
Provider Name (Legal Business Name): RURAL HEALTH CARE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
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

PO BOX 817
PALATKA FL
32178-0817
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2530
  • Fax: 904-829-2924
Mailing address:
  • Phone: 386-328-0108
  • Fax: 386-325-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26334
License Number StateFL

VIII. Authorized Official

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