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2349 Village Square Pkwy Ste 110-111 Fleming Island FL 32003-6355 | |
| (904) 385-2023 | |
| (904) 385-2454 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2349 Village Square Pkwy Ste 110-111, Fleming Island, Florida |
| Authorized Official Name and Position | Anita H. Rembert (CEO) |
| Authorized Official Contact | 3524634501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
23476 Nw 186th Ave High Springs FL 32643-0673 Ph: (386) 454-0698 | 2349 Village Square Pkwy Ste 110-111 Fleming Island FL 32003-6355 Ph: (904) 385-2023 |
| NPI Number | 1275220238 |
|---|---|
| Provider Enumeration Date | 04/20/2023 |
| Last Update Date | 01/10/2025 |
| Medicare PECOS PAC ID | 2365359387 |
|---|---|
| Medicare Enrollment ID | O20231006002346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275220238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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