Healthcare Provider Details

I. General information

NPI: 1669548392
Provider Name (Legal Business Name): WEIRSDALE FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 S HIGHWAY 25
WEIRSDALE FL
32195-0008
US

IV. Provider business mailing address

16400 S HIGHWAY 25
WEIRSDALE FL
32195-2442
US

V. Phone/Fax

Practice location:
  • Phone: 352-821-9797
  • Fax: 352-821-0553
Mailing address:
  • Phone: 352-821-9797
  • Fax: 352-821-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DHARTI BISHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-821-9797