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General NPI Number Information
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NPI Number | 1629247259
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Entity Type | Organization
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Legal Business Name | CYPRESS HEALTH SYSTEMS FLORIDA INC.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 125 SW 7TH ST
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City | WILLISTON
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State | FL
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Zip | 32696-2403
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Country | US
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Telephone | 352-528-2801
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Fax | 352-528-3824
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Provider Business Mailing Address
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Address Line | 125 SW 7TH STREET
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City | WILLISTON
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State | FL
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Zip | 32696-2403
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Country | US
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Telephone | 352-528-2801
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Fax | 352-528-3824
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Authorized Official
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Title or Position | CEO
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Name | MR. JERRY E GILLMAN
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Credential |
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Telephone | 352-528-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 4424
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License Number State | FL
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