Provider Demographics
NPI:1902944747
Name:FLORIDA FAMILY RURAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:FLORIDA FAMILY RURAL HEALTH CARE LLC
Other - Org Name:AVON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:863-453-2500
Mailing Address - Street 1:2398 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9523
Mailing Address - Country:US
Mailing Address - Phone:863-453-2500
Mailing Address - Fax:863-453-0745
Practice Address - Street 1:2398 HARTFORD DR
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9523
Practice Address - Country:US
Practice Address - Phone:863-453-2500
Practice Address - Fax:863-453-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1725261Q00000X
FLME 91882261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660069700Medicaid
FL290263000Medicaid
FLI23901Medicare UPIN
FL290263000Medicaid