Provider Demographics
NPI:1912251562
Name:HISCARE CLINIC LLC
Entity Type:Organization
Organization Name:HISCARE CLINIC LLC
Other - Org Name:HISCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-693-3055
Mailing Address - Street 1:4577 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-5030
Mailing Address - Country:US
Mailing Address - Phone:850-693-3055
Mailing Address - Fax:850-482-5208
Practice Address - Street 1:4577 COLLINS RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-5030
Practice Address - Country:US
Practice Address - Phone:850-693-3055
Practice Address - Fax:850-482-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHISCARE07Medicaid
FLHISCARE07Medicaid