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General NPI Number Information
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NPI Number | 1770570806
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Entity Type | Organization
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Legal Business Name | RURAL MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 411 WEBSTER ST
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City | WILDWOOD
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State | FL
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Zip | 34785-4036
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Country | US
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Telephone | 352-748-6689
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Fax | 352-748-6381
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Provider Business Mailing Address
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Address Line | 605 LAMAR AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3211
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Country | US
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Telephone | 352-799-5411
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Fax | 352-544-2713
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Authorized Official
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Title or Position | V.P. OPERATIONS
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Name | MR. CHARLES WILLIAM COSNER
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Credential |
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Telephone | 352-799-5411
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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 | FL
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 5025
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License Number State | FL
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