Provider Demographics
NPI:1083178412
Name:SPECIALTY CARE SERVICES INC
Entity Type:Organization
Organization Name:SPECIALTY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-258-4015
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0483
Mailing Address - Country:US
Mailing Address - Phone:352-258-4015
Mailing Address - Fax:215-559-6336
Practice Address - Street 1:701 SE 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7665
Practice Address - Country:US
Practice Address - Phone:352-209-2431
Practice Address - Fax:215-559-6336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016981800Medicaid