Provider Demographics
NPI:1598103004
Name:DISTRICT CLINIC HOLDINGS, INC.
Entity Type:Organization
Organization Name:DISTRICT CLINIC HOLDINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-804-5885
Mailing Address - Street 1:1515 N FLAGLER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3429
Mailing Address - Country:US
Mailing Address - Phone:561-659-1270
Mailing Address - Fax:561-804-5790
Practice Address - Street 1:1515 N FLAGLER DR STE 101
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3429
Practice Address - Country:US
Practice Address - Phone:561-659-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008037106Medicaid
FL008037124Medicaid
FL008037102Medicaid
FL008037118Medicaid
FL008037100Medicaid
FL008037104Medicaid
FL008037112Medicaid
FL008037123Medicaid