Provider Demographics
NPI:1811739873
Name:FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOOGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-819-4088
Mailing Address - Street 1:110 HEALTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-823-3401
Mailing Address - Fax:
Practice Address - Street 1:110 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-823-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAGLER PROFESSIONAL HEALTH CARE SERV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care