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General NPI Number Information
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NPI Number | 1114994944
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Entity Type | Organization
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Legal Business Name | RURAL HEALTH CARE INCORPORATED
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 22066 SE 71ST AVENUE
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City | HAWTHORNE
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State | FL
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Zip | 32640-3969
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Country | US
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Telephone | 352-481-2700
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Fax | 352-481-2392
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Provider Business Mailing Address
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Address Line | 1302 RIVER ST
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City | PALATKA
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State | FL
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Zip | 32177-5042
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Country | US
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Telephone | 386-328-0108
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Fax | 386-325-1086
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LAURA M. SPENCER
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Credential |
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Telephone | 386-328-0108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | L8000011321
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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