Organization
FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
Active
Other names
selected
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN T MYLES (CEO)
(386) 758-5552
Entity
Organization
Contact information
Practice address
173 NW ALBRITTON LN, LAKE CITY, FL 32055-0249
(386) 758-5552
(386) 752-9143
Mailing address
PO BOX 249, LAKE CITY, FL 32056-0249
(386) 758-5552
(386) 752-9143
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME92183
FL
261Q00000X
Clinic/Center
Primary
5080000065
FL
363A00000X
Physician Assistant
PA0003548
FL
363A00000X
Physician Assistant
PA9101298
FL
363L00000X
Nurse Practitioner
1181972
FL
363L00000X
Nurse Practitioner
ARNP2908802
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023552300
—
FL
05
—
033364600
—
FL
01
—
1181972
FLORIDA LICENSE
FL
05
—
273713200
—
FL
05
—
290374100
—
FL
05
—
292277100
—
FL
01
—
5080000065
ORIGINAL LICENSE
FL
01
—
ME92183
STATE LICENSE
FL
01
—
PA0003548
FLORIDA LICENSE
FL
01
—
PA9101298
FLORIDA LICENSE
FL
Enumeration date
04/04/2006
Last updated
10/15/2010
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