Provider Demographics
NPI:1629247259
Name:CYPRESS HEALTH SYSTEMS FLORIDA INC.
Entity Type:Organization
Organization Name:CYPRESS HEALTH SYSTEMS FLORIDA INC.
Other - Org Name:TRI COUNTY FAMILY HEALTH SERVICES-WILLISTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-528-2801
Mailing Address - Street 1:125 SW 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2403
Mailing Address - Country:US
Mailing Address - Phone:352-528-2801
Mailing Address - Fax:352-528-3824
Practice Address - Street 1:125 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2403
Practice Address - Country:US
Practice Address - Phone:352-528-2801
Practice Address - Fax:352-528-3824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYPRESS HEALTH SYSTEMS FLORIDA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4424261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72816OtherBLUE CROSS
FL660137500Medicaid
FL332OtherBCBS OF FL
FL660137500Medicaid
FL103421Medicare Oscar/Certification