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General NPI Number Information
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NPI Number | 1568630606
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE HOUSECALLS INC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 1220 SE 95TH ST
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City | OCALA
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State | FL
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Zip | 34480-7884
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Country | US
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Telephone | 352-854-4985
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Fax | 352-854-4985
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Provider Business Mailing Address
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Address Line | 1220 SE 95TH ST
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City | OCALA
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State | FL
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Zip | 34480-7884
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Country | US
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Telephone | 352-854-4985
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Fax | 352-854-4985
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DOUGLAS P. NAGLE
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Credential | PA-C
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Telephone | 352-854-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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