Organization
NEIGHBORHOOD MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELLIE R GRAHAM (CREDENTIALING MANAGER)
(850) 577-0045
Entity
Organization
Contact information
Practice address
1210 KEMP RD, HAVANA, FL 32333-1938
(850) 539-8222
Mailing address
1210 KEMP RD, HAVANA, FL 32333-1938
(850) 539-8222
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262263720
—
FL
Enumeration date
05/31/2018
Last updated
05/31/2018
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