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General NPI Number Information
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NPI Number | 1962464248
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 173 NW ALBRITTON LN
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City | LAKE CITY
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State | FL
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Zip | 32055-0249
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Country | US
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Telephone | 386-758-5552
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Fax | 386-752-9143
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | LAKE CITY
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State | FL
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Zip | 32056-0249
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Country | US
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Telephone | 386-758-5552
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Fax | 386-752-9143
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN T MYLES
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Credential |
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Telephone | 386-758-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0003548
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME92183
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101298
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1181972
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP2908802
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5080000065
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License Number State | FL
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