# WILLISTON RURAL HEALTH AND WELLNESS CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538435375
- **Authorized official:** MR. SIDNEY ERNEST CLEVINGER M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (352) 266-7075

## Contact information

- **Practice address:** 300 NW 1ST AVE, WILLISTON, FL 32696-2006
- **Practice address phone:** (352) 529-0966
- **Practice address fax:** (352) 529-0967
- **Mailing address:** 300 NW 1ST AVE, WILLISTON, FL 32696-2006
- **Mailing address phone:** (352) 529-0966
- **Mailing address fax:** (352) 529-0967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/27/2012
- **Last updated:** 10/10/2013