NPIMap

Organization Active NPI

Rural Health Care, Inc.

  • Community/Retail Pharmacy
  • Crescent City, FL
National Provider Identifier
1689756470
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH0016495 Issued in FL
Legal business name
RURAL HEALTH CARE, INC.
Doing business as
Aza Health
Practice address
306 Union Ave
Crescent City, FL 32112-4432
Phone
(386) 698-2368
Fax
(386) 698-4343
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Authorized official

Name
Larry William Pederson, RPH, CPH
Title
VP/Cpo
Phone
(386) 328-0558

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PH0016495 FL
Community/Retail Pharmacy 3336C0003X PH0016495 FL Primary

Addresses

Primary practice location

306 Union Ave
Crescent City, FL 32112-4432

Mailing address

PO Box 817
Palatka, FL 32178-0817

Other identifiers 3

IdentifierTypeStateIssuer
021632100MedicaidFL
021632179MedicaidFL
1085960OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Aza Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Care Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1689756470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 817",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321780817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 UNION AVE",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321124432",
            "telephone_number": "386-698-2368",
            "fax_number": "386-698-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "VP/CPO",
        "authorized_official_telephone_number": "386-328-0558",
        "authorized_official_credential": "RPH, CPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH0016495",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH0016495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021632100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021632179",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1085960",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aza Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crescent City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; 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.