Provider Demographics
NPI:1609275924
Name:BARNES HEALTHCARE OF FL LLC
Entity Type:Organization
Organization Name:BARNES HEALTHCARE OF FL LLC
Other - Org Name:BARNES HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-245-6039
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0160
Mailing Address - Country:US
Mailing Address - Phone:229-245-6039
Mailing Address - Fax:888-276-7881
Practice Address - Street 1:5483 W WATERS AVE
Practice Address - Street 2:SUITE 1200 N
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1205
Practice Address - Country:US
Practice Address - Phone:229-245-6039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH283723336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4720760014Medicaid
FL102459100Medicaid