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General NPI Number Information
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NPI Number | 1912641341
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA RURAL HEALTH CORP
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 680 MAPLE ST
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1826
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Country | US
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Telephone | 850-999-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 600 34TH ST S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33711-1722
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Country | US
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Telephone | 850-999-3181
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | MR. TRACI THOMPSON
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Credential | MD
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Telephone | 410-493-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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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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Taxonomy #4
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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