Provider Demographics
NPI:1477830453
Name:RTA HEALTH CARE
Entity Type:Organization
Organization Name:RTA HEALTH CARE
Other - Org Name:INJURY CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-994-4833
Mailing Address - Street 1:PO BOX 49307
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32240-9307
Mailing Address - Country:US
Mailing Address - Phone:904-994-4833
Mailing Address - Fax:
Practice Address - Street 1:5222 LENOX AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4838
Practice Address - Country:US
Practice Address - Phone:904-783-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207P00000X, 364S00000X
FL1477830453208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty