Organization
PANHANDLE RURAL HEALTH INCORPORATED
Active
Other names
Jay Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEATIOUS DAVID SMITH I MD (OWNER SUPERVISING PHYSICIAN)
(850) 675-4546
Entity
Organization
Contact information
Practice address
14088 ALABAMA ST, JAY, FL 32565-1036
(850) 675-4546
(850) 675-4548
Mailing address
PO BOX 10, JAY, FL 32565-0010
(850) 675-4546
(850) 675-4548
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21333
BCBS OF FLORIDA GROUP NUMBER
FL
05
—
660022100
—
FL
05
—
660022102
—
FL
Enumeration date
04/26/2006
Last updated
07/05/2012
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