NPIMap

Organization Active NPI

Florida Department of Health

Doing business as Lafayette County Health Department

  • Public Health or Welfare Agency
  • Mayo, FL
National Provider Identifier
1386611085
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
FLORIDA DEPARTMENT OF HEALTH
Doing business as
Lafayette County Health Department
Practice address
140 SW Virginia Cir
Mayo, FL 32066-4064
Phone
(386) 294-1321
Fax
(386) 294-3876
NPI assigned
Mar 2, 2006
Last updated
Jul 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
FL DEPARTMENT OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Mr. Kerry S Waldron
Title
Administrator
Phone
(386) 362-2708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

140 SW Virginia Cir
Mayo, FL 32066-4064

Mailing address

PO Box 6030
Live Oak, FL 32064-6030
Phone (386) 362-2708

Other identifiers 1

IdentifierTypeStateIssuer
029034300MedicaidFL

Other names 1

  • Lafayette County Health Department Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100504000843 FL Part B Supplier - Public Health/Welfare Agency 3072424282 Receives reassigned benefits from 7 practitioners
Practice locations: Mayo, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0674990Florida Department of Health in Lafayette County140 SW Virginia Circle, Mayo, FL 32066Provider-performed microscopySep 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Agape Community Health185 organizations share this tax ID, including this one
Part of
Agape Community Health

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Walton Community Health CenterDefuniak Springs, FL, CCN 101136 Federally qualified health center Operational/Managerial Control (100%) Sep 7, 2010
Bradford Community Health Care IncStarke, FL, CCN 101182 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1386611085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6030",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320646030",
            "telephone_number": "386-362-2708",
            "fax_number": "386-362-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SW VIRGINIA CIR",
            "city": "MAYO",
            "state": "FL",
            "postal_code": "320664064",
            "telephone_number": "386-294-1321",
            "fax_number": "386-294-3876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FL DEPARTMENT OF HEALTH",
        "enumeration_date": "2006-03-02",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-362-2708",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029034300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lafayette County Health Department",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lafayette County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayo, FL

Sources for this page

Verify at the official NPI Registry.