Provider Demographics
NPI:1710923727
Name:HEART OF FLORIDA HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HEART OF FLORIDA HEALTH CENTER, INC
Other - Org Name:COMMUNITY HEALTH SERVICES OF MARION COUNTY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-6599
Mailing Address - Street 1:1025 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0900
Mailing Address - Country:US
Mailing Address - Phone:352-732-6599
Mailing Address - Fax:352-732-4816
Practice Address - Street 1:1025 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0900
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:352-732-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033956300Medicaid
FL001718300Medicaid