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1426 Canyon Ave Ne Unit B Live Oak FL 32064-4832 | |
| (386) 208-0537 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1426 Canyon Ave Ne, Live Oak, Florida |
| Authorized Official Name and Position | Paula Lalor (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Contact | 6159254565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1426 Canyon Ave Ne Unit B Live Oak FL 32064-4832 Ph: (386) 208-0537 | 1426 Canyon Ave Ne Unit B Live Oak FL 32064-4832 Ph: (386) 208-0537 |
| NPI Number | 1669568499 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 02/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669568499 | NPI | - | NPPES |
| 660120100 | Medicaid | FL | |
| CE9137 | Other | FL | MEDICARE RAIL ROAD |
| 660120101 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 4314 (Florida) | Primary |
Acv Community Services Ll Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10820 Marvin E Jones Blvd, Live Oak, FL 32060 Phone: 386-658-5341 | |
Horizon Pediatrics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Demorest St Se, Live Oak, FL 32064 Phone: 386-362-5437 Fax: 386-362-5440 | |