| Organization Name: | JESSIE TRICE COMMUNITY HEALTH CENTER INC |
| NPI Number: | 1861863458 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNIE R NEASMAN (PRESIDENT/CEO) |
| Mailing Address: | 3301 Nw 183rd Street Carol City |
| State: | FL US |
| Postal Code: | 330562999 |
| Phone Number: | 3056376400 |
| Fax Number: | 3058351598 |
| NPI Enumeration Date: | 10/08/2015 |
| NPI Last Update Date: | 10/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |