Organization
RURAL MEDICAL ASSOCIATES INC
Active
Other names
WILDWOOD MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WILLIAM COSNER (V.P. OPERATIONS)
(352) 799-5411
Entity
Organization
Contact information
Practice address
411 WEBSTER ST, WILDWOOD, FL 34785-4036
(352) 748-6689
(352) 748-6381
Mailing address
605 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 799-5411
(352) 544-2713
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
FL
261QR1300X
Rural Health Clinic/Center
Primary
5025
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34382
BC/BS FLA
FL
05
—
660111100
—
FL
05
—
660111101
—
FL
01
—
CK4235
RAILROAD MEDICARE
FL
Enumeration date
10/04/2005
Last updated
07/16/2008
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