| |
765 E Saint Johns Ave Hastings FL 32145-3936 | |
(904) 692-2920 | |
(904) 692-3611 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 765 E Saint Johns Ave, Hastings, Florida |
Authorized Official Name and Position | Laura M. Spencer (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3863280108 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1302 River St Palatka FL 32177-5042 Ph: (386) 328-0108 | 765 E Saint Johns Ave Hastings FL 32145-3936 Ph: (904) 692-2920 |
NPI Number | 1356318885 |
---|---|
Provider Enumeration Date | 03/03/2006 |
Last Update Date | 06/13/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356318885 | NPI | - | NPPES |
029545407 | Medicaid | FL | |
029543408 | Medicaid | FL |