| Aza Health | |
|
1213 State Road 20 Interlachen FL 32148-2737 | |
| (386) 684-4914 | |
| (386) 684-4154 |
| Full Name | Aza Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 1213 State Road 20, Interlachen, Florida |
| Authorized Official Name and Position | Laura M. Spencer (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3863280108 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aza Health 1302 River St Palatka FL 32177-5042 Ph: (386) 328-0108 | Aza Health 1213 State Road 20 Interlachen FL 32148-2737 Ph: (386) 684-4914 |
| NPI Number | 1477529311 |
|---|---|
| Provider Enumeration Date | 02/28/2006 |
| Last Update Date | 02/13/2020 |
| Certification Date | 02/13/2020 |
| Medicare PECOS PAC ID | 7214849520 |
|---|---|
| Medicare Enrollment ID | O20031106000267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477529311 | NPI | - | NPPES |
| 101251779 | Medicaid | FL | |
| 029543402 | Medicaid | FL | |
| CF6528 | Other | FL | MEDICARE RAILROAD |
| 037641801 | Medicaid | FL | |
| 99262 | Other | FL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | L8000010911 (Florida) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |