Provider Demographics
NPI:1912641341
Name:NORTH FLORIDA RURAL HEALTH CORP
Entity Type:Organization
Organization Name:NORTH FLORIDA RURAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-493-3901
Mailing Address - Street 1:600 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1722
Mailing Address - Country:US
Mailing Address - Phone:850-999-3181
Mailing Address - Fax:
Practice Address - Street 1:680 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1826
Practice Address - Country:US
Practice Address - Phone:850-999-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No347B00000XTransportation ServicesBus