NPIMap

Organization Active NPI

Acv Community Services LLC

  • Rural Health Clinic/Center
  • Live Oak, FL
National Provider Identifier
1174630693
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACV COMMUNITY SERVICES LLC
Practice address
10820 Marvin E. Jones Blvd.
Live Oak, FL 32060-5890
Phone
(386) 658-5550
Fax
(386) 658-5666
NPI assigned
Aug 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Craig A. Carter
Title
President/Ceo
Phone
(386) 658-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

10820 Marvin E. Jones Blvd.
Live Oak, FL 32060-5890

Mailing address

PO Box 4675
Dowling Park, FL 32064-1507
Phone (386) 658-5450

Other identifiers 4

IdentifierTypeStateIssuer
230620OtherFLAVMED
W01OtherFLBCBS CLINIC UB92
029511600MedicaidFL
379125400MedicaidFL

Other names 1

  • Copeland Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031013000024 FL Part A Provider - Rural Health Clinic 3476462078 Practice locations: Live Oak, FL
O20040402000091 FL Part B Supplier - Clinic/Group Practice 3476462078 Receives reassigned benefits from 17 practitioners
Practice locations: Live Oak, FL

Rural health clinic certification: CCN 103819

Legal name
ACV COMMUNITY SERVICES LLC
Doing business as
COPELAND MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1982
Last certification
Aug 8, 2023
Ownership / control type
2B
Organization structure
LLCNon-profit
Enrollment address
10820 Marvin E Jones Blvd
Live Oak, FL 32060-8243

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Acv Community Services LLC Organization, Live Oak, FL LLC 5% Or Greater Direct Ownership Interest Nov 1, 2003
Kerri Hilliard Individual Operational/Managerial ControlChief Operating Officer May 1, 2010
Craig Carter Individual Operational/Managerial ControlPresident/Ceo Sep 1, 2008
Michael Willis Individual Corporate OfficerCfo/Vice President of Finance May 13, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1174630693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4675",
            "city": "DOWLING PARK",
            "state": "FL",
            "postal_code": "320641507",
            "telephone_number": "386-658-5450",
            "fax_number": "386-658-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 MARVIN E. JONES BLVD.",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320605890",
            "telephone_number": "386-658-5550",
            "fax_number": "386-658-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACV COMMUNITY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "386-658-5500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "230620",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CLINIC UB92",
            "identifier": "W01",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029511600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379125400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copeland Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Live Oak, FL

Sources for this page

Verify at the official NPI Registry.