Provider Demographics
NPI:1164584975
Name:RURAL HEALTH NETWORK OF MONROE COUNTY, FL, INC.
Entity Type:Organization
Organization Name:RURAL HEALTH NETWORK OF MONROE COUNTY, FL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA
Authorized Official - Phone:305-517-6613
Mailing Address - Street 1:3706 N ROOSEVELT BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4566
Mailing Address - Country:US
Mailing Address - Phone:305-517-6613
Mailing Address - Fax:305-517-6617
Practice Address - Street 1:3706 N ROOSEVELT BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4566
Practice Address - Country:US
Practice Address - Phone:305-517-6613
Practice Address - Fax:305-517-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660170700Medicaid
FL660172300Medicaid
FL660161800Medicaid
FL660161801Medicaid
FL660171500Medicaid
FL660161800Medicaid
FL660170700Medicaid