SNC Holding Company LLC – Rural Health Clinic/Center

Key facts

NPI: 1124405022
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 261QR1300X
Legal business name: SNC HOLDING COMPANY LLC
Practice address: 17805 N US Highway 301
Citra, FL 32113-2459
Phone: (352) 595-7777
Fax: (352) 595-4047
NPI assigned: Apr 29, 2015
Organization subpart: No

Authorized official

Name: Mr. Frederick C Spogen III, RPHCP
Title: Ceo
Phone: (352) 572-0666

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Sidney Ernest Clevinger, MD Family Medicine Physician · Ocala, FL · NPI 1760461974

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CONTRACTED MANAGING EMPLOYEE · CORPORATE DIRECTOR · CORPORATE OFFICER

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL

Rural health clinic certification: CCN 103966

Legal name: SNC HOLDING COMPANY LLC
Doing business as: CITRA FAMILY HEALTH
Certification status: Active
Provider type (POS): Rural health clinic
Participating since: May 21, 1997
Last certification: Sep 15, 2020
Ownership / control type: 1B
Most recent change of ownership: Mar 15, 2015 (2 total)
Organization structure: LLC · Proprietary
Incorporated: Mar 23, 2015 in FL
Enrollment address: 17805 N US Highway 301
Citra, FL 32113-2459

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since	Share
Frederick Spogen Individual	5% Or Greater Direct Ownership Interest	Mar 15, 2015	50%
	Corporate Officer Ceo	Mar 15, 2015	50%
	Corporate Director Ceo	Mar 15, 2015	50%
Sidney E Clevinger Individual	Contracted Managing Employee Medical Director	Mar 15, 2015	50%
	5% Or Greater Direct Ownership Interest	Mar 15, 2015	50%
	Corporate Officer Medical Director	Mar 15, 2015	50%
	Corporate Director Medical Director	Mar 15, 2015	50%

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20160113002539	FL	Part a Provider - Rural Health Clinic	1355643917	Practice locations: Citra, FL

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X			Yes

Addresses

Primary practice location

17805 N US Highway 301
Citra, FL 32113-2459

Mailing address

17805 N US Highway 301
Citra, FL 32113-2459
Phone (352) 595-7777

Other names

citra family health Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 29, 2015.

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1124405022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17805 N US HIGHWAY 301",
            "city": "CITRA",
            "state": "FL",
            "postal_code": "321132459",
            "telephone_number": "352-595-7777",
            "fax_number": "352-595-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17805 N US HIGHWAY 301",
            "city": "CITRA",
            "state": "FL",
            "postal_code": "321132459",
            "telephone_number": "352-595-7777",
            "fax_number": "352-595-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNC HOLDING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "SPOGEN",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-572-0666",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "RPHCP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "citra family health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Citra, FL

All providers in Citra, FL · Rural Health Clinic/Center in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.