Provider Demographics
NPI:1568630606
Name:COUNTRYSIDE HOUSECALLS INC
Entity Type:Organization
Organization Name:COUNTRYSIDE HOUSECALLS INC
Other - Org Name:COUNTRYSIDE HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:352-854-4985
Mailing Address - Street 1:1220 SE 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7884
Mailing Address - Country:US
Mailing Address - Phone:352-854-4985
Mailing Address - Fax:352-854-4985
Practice Address - Street 1:1220 SE 95TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7884
Practice Address - Country:US
Practice Address - Phone:352-854-4985
Practice Address - Fax:352-854-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care