Rural Health Care Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Interlachen, FL
NPI 1477529311 · NPPES record last updated Feb 13, 2020
Key facts
- NPI
- 1477529311
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH CARE INCORPORATED
- Practice address
- 1213 State Road 20
Interlachen, FL 32148-2737 - Phone
- (386) 684-4914
- Fax
- (386) 684-4154
- NPI assigned
- Feb 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Miss Laura M. Spencer, C.E.O.
- Title
- President/Chief Executive Officer
- Phone
- (386) 328-0108
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 10
Practitioners 36
-
Amanda Willard, APRN
-
Carlos D Amy Vazquez, M.D.
-
Cynthia Burnett, FNP
-
Carlton Dicarlo, PA
-
Obioma Anthony Esomonu, M.D.
-
Terry Lishone Gilyard, APRN
-
Iftikhar Fazal Haq, D.O.
-
Michelle Kessler, FNP-BC
-
Dominique Long, APRN
-
Milagros Montalvo, M.D.
-
Hezekiah George Owojuyigbe, M.D, M.P.H.
-
Aixsa Perez, M.D.
-
Beatrice Perez, APRN
-
Ana Marie Seijas, M.D.
-
Rosan Marie Sequeda, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Federally qualified health center certification: CCN 101891
- Legal name
- RURAL HEALTH CARE INCORPORATED
- Doing business as
- AZA HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 20, 1993
- Last certification
- Apr 20, 1993
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 8, 1977 in FL
- Enrollment address
- 1213 State Road 20
Interlachen, FL 32148-2737
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Kathy L Dean |
Corporate Director | Sep 29, 2010 | |
| Sabrina Thomas |
Corporate Director | Sep 20, 2010 | |
| Mary Pipa |
W-2 Managing Employee | Sep 17, 2010 | |
| Elizabeth C Fisher |
Corporate Director | Sep 29, 2010 | |
| Laura Spencer |
Corporate Officer |
Jun 25, 2010 | |
| Corporate Director | Jun 25, 2010 | ||
| W-2 Managing Employee | Jun 25, 2010 | ||
| Joseph Giacomo |
Corporate Officer |
May 20, 2019 | |
| W-2 Managing Employee |
May 20, 2019 | ||
| Donavan Bardier |
Corporate Director |
Jan 1, 2024 | |
| Lucia Valdivia-Sanchez |
Corporate Director |
Jan 28, 2019 | |
| Moses a Floyd |
Corporate Director | Jan 1, 2013 | |
| Constance Schneider |
Corporate Director |
Jan 1, 2020 | |
| Lashonda Simmons-Watson |
Corporate Director | Sep 20, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000267 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 7214849520 |
1 other NPI on this enrollment Practice locations: Interlachen, FL |
| O20031219000375 | FL | Part B Supplier - Clinic/Group Practice | 7214849520 |
Receives reassigned benefits from 82 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Keystone Heights, FL; Welaka, FL; St Augustine, FL; Palm Coast, FL; Palatka, FL; Interlachen, FL; Hawthorne, FL; Hasting, FL… |
National Provider Directory
Locations
22066 SE 71st Ave
Hawthorne, FL 32640
Phone (352) 481-2700
1213 State Road 20
Interlachen, FL 32148
Phone (386) 684-2407
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | L8000010911 | FL | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1213 State Road 20
Interlachen, FL 32148-2737
Mailing address
1302 River St
Palatka, FL 32177-5042
Phone (386) 328-0108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101251779 | Medicaid | FL | |
| 029543402 | Medicaid | FL | |
| CF6528 | Other | FL | MEDICARE RAILROAD |
| 037641801 | Medicaid | FL | |
| 99262 | Other | FL | BLUE CROSS BLUE SHIELD |
Other names
- Aza Health
Other providers in Interlachen, FL
- Melisa T Crosby, PT P.a.
- Metro Pharmaceutical Services Inc
- Veronica Milton
- John T Phipps
- Natalie L Romero-Newcomer
- Rural Health Care, Inc.
- Joanne Sheptock
- Lisa Anne St Pierre
- Tracy Lynn Steinmetz
- Crysta Stepaniak
All providers in Interlachen, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2020. 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.