NPIMap

Organization Active NPI

Northeast Florida Health Services, Inc.

Doing business as Family Health Source

  • Family Medicine Physician
  • Pierson, FL
National Provider Identifier
1609543503
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Doing business as
Family Health Source
Practice address
216 Frederick St
Pierson, FL 32180-3024
Phone
(386) 749-9449
Fax
(386) 749-9447
NPI assigned
Aug 27, 2021
Organization subpart
Yes
Parent organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
Rebecca Collier
Title
Credentialing/Contracts Admin
Phone
(386) 202-6025

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

216 Frederick St
Pierson, FL 32180-3024

Mailing address

1205 S Woodland Blvd Ste 3
Deland, FL 32720-7464
Phone (386) 202-6025

Other identifiers 1

IdentifierTypeStateIssuer
687955101MedicaidFL

Other names 1

  • FAMILY HEALTH SOURCE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Florida Health11 organizations share this tax ID, including this one
Part of
Northeast Florida Health

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1609543503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 S WOODLAND BLVD STE 3",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207464",
            "telephone_number": "386-202-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 FREDERICK ST",
            "city": "PIERSON",
            "state": "FL",
            "postal_code": "321803024",
            "telephone_number": "386-749-9449",
            "fax_number": "386-749-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST FLORIDA HEALTH SERVICES, INC.",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CREDENTIALING/CONTRACTS ADMIN",
        "authorized_official_telephone_number": "386-202-6025"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687955101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY HEALTH SOURCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pierson, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.