Provider Demographics
NPI:1407971922
Name:GARCIA MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:GARCIA MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-892-4791
Mailing Address - Street 1:411 E NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-7444
Mailing Address - Country:US
Mailing Address - Phone:850-892-4791
Mailing Address - Fax:850-892-3868
Practice Address - Street 1:411 E NELSON AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7444
Practice Address - Country:US
Practice Address - Phone:850-892-4791
Practice Address - Fax:850-892-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59559208D00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052715700Medicaid
FL11921OtherBLUE CROSS-BLUE SHIELD
FLME59559OtherCOMMERCIAL BILLING
FL660200200Medicaid
FLME59559OtherCOMMERCIAL BILLING
FL108975Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
FL660200200Medicaid