Provider Demographics
NPI:1669548392
Name:WEIRSDALE FAMILY HEALTH CENTER INC
Entity type:Organization
Organization Name:WEIRSDALE FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DHARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-821-9797
Mailing Address - Street 1:16400 S HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:WEIRSDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32195-2442
Mailing Address - Country:US
Mailing Address - Phone:352-821-9797
Mailing Address - Fax:352-821-0553
Practice Address - Street 1:16400 S HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:WEIRSDALE
Practice Address - State:FL
Practice Address - Zip Code:32195-0008
Practice Address - Country:US
Practice Address - Phone:352-821-9797
Practice Address - Fax:352-821-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 363AM0700X, 363L00000X
FL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty