| |
550 W. Georgia St Starke FL 32091-1816 | |
(904) 364-2900 | |
(904) 364-2901 |
Full Name | |
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Speciality | Clinic/Center |
Location | 550 W. Georgia St, Starke, Florida |
Authorized Official Name and Position | Anita H. Rembert (CEO) |
Authorized Official Contact | 3864540698 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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23476 Nw 186th Ave High Springs FL 32643-0673 Ph: (386) 454-0698 | 550 W. Georgia St Starke FL 32091-1816 Ph: (904) 364-2900 |
NPI Number | 1912213000 |
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Provider Enumeration Date | 08/26/2010 |
Last Update Date | 01/10/2025 |
Medicare PECOS PAC ID | 2365359387 |
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Medicare Enrollment ID | O20101029000200 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912213000 | NPI | - | NPPES |
029506015 | Medicaid | FL | |
029506016 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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