Polk Correctional Institution

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

PA9100731 Issued in FL

Legal business name

POLK CORRECTIONAL INSTITUTION

Practice address

10800 Evans Rd
Polk City, FL 33868-6925

Phone

(863) 984-2273

Fax

(863) 984-1021

NPI assigned

Jan 8, 2013

Last updated

Jan 8, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Long N DO, MD

Title

Chief Health Officer

Phone

(863) 984-2273

Specialties & licenses 1

Addresses

Other names 1

• Florida Department of Corrections Other name

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

CLIA laboratory certificates

Tax ID family

Florida Department of Corrections2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• North Florida Reception Center

  • Institutional Pharmacy
  • Lake Butler, FL
  • NPI 1083809883
  NPD tax ID

Locations

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357603200000",
    "number": "1679810972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 MCCREA DR",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335493583",
            "telephone_number": "863-984-2273",
            "fax_number": "863-984-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 EVANS RD",
            "city": "POLK CITY",
            "state": "FL",
            "postal_code": "338686925",
            "telephone_number": "863-984-2273",
            "fax_number": "863-984-1021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK CORRECTIONAL INSTITUTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-08",
        "last_updated": "2013-01-08",
        "status": "A",
        "authorized_official_last_name": "DO",
        "authorized_official_first_name": "LONG",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CHIEF HEALTH OFFICER",
        "authorized_official_telephone_number": "863-984-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": "PA9100731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Department of Corrections",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kreative Dental Care PA
• Kristen Smith
• Edgar Morales
• Maria Auxiliadora Painter, DNP, AGNP-BC
• Polk City Pharmacy Inc (Medicine Shoppe)
• Quality Care HHS
• Paula Cleopatra Quintero
• Diego Ramirez, ATC, LAT, LMT.
• Rapid Speech Therapy LLC
• Beverly Reaves, RN

• Health Maintenance Organization in Polk City, FL
• Providers in Polk City, FL by specialty
• Health Maintenance Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.