Provider Demographics
NPI:1588295752
Name:PANHANDLE RURAL HEALTH & PRIMARY CARE INC
Entity type:Organization
Organization Name:PANHANDLE RURAL HEALTH & PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-353-7689
Mailing Address - Street 1:20274 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-1957
Mailing Address - Country:US
Mailing Address - Phone:850-353-7689
Mailing Address - Fax:
Practice Address - Street 1:20274 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1957
Practice Address - Country:US
Practice Address - Phone:850-353-7689
Practice Address - Fax:850-674-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110740900Medicaid