Provider Demographics
NPI:1629192919
Name:RUDD FAMILY HEALTH CARE INC
Entity Type:Organization
Organization Name:RUDD FAMILY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-263-3964
Mailing Address - Street 1:4369 PEANUT RD
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32431-6557
Mailing Address - Country:US
Mailing Address - Phone:850-263-5574
Mailing Address - Fax:
Practice Address - Street 1:5517 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1307
Practice Address - Country:US
Practice Address - Phone:850-263-3964
Practice Address - Fax:850-263-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3306442261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center