Healthcare Provider Details

I. General information

NPI: 1407191299
Provider Name (Legal Business Name): PROJECT HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 N LECANTO HWY
SUMTERVILLE FL
33585-5141
US

IV. Provider business mailing address

1425 S US 301
SUMTERVILLE FL
33585-5141
US

V. Phone/Fax

Practice location:
  • Phone: 352-793-5900
  • Fax: 352-687-2804
Mailing address:
  • Phone: 352-793-5900
  • Fax: 352-687-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26437
License Number StateFL

VIII. Authorized Official

Name: MR. THOMAS CHASE
Title or Position: CEO
Credential:
Phone: 352-793-5900