Provider Demographics
NPI:1174630693
Name:ACV COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:ACV COMMUNITY SERVICES LLC
Other - Org Name:COPELAND CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-658-5500
Mailing Address - Street 1:PO BOX 4675
Mailing Address - Street 2:
Mailing Address - City:DOWLING PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1507
Mailing Address - Country:US
Mailing Address - Phone:386-658-5450
Mailing Address - Fax:386-658-5111
Practice Address - Street 1:10820 MARVIN E. JONES BLVD.
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-5890
Practice Address - Country:US
Practice Address - Phone:386-658-5550
Practice Address - Fax:386-658-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230620OtherAVMED
FLW01OtherBCBS CLINIC UB92
FL029511600Medicaid
FL379125400Medicaid
FL379125400Medicaid
FL103819Medicare Oscar/Certification
FL99465Medicare ID - Type UnspecifiedMEDICARE PART B