MEDICARE: NORTH PORT PRIMARY CARE ASSOCIATION PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME95735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003133455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PORT PRIMARY CARE ASSOCIATION PL

Provider Business Mailing Address
First Line	:	PO BOX 7825
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34290-0825
Country	:	US
Telephone Number	:	941-429-4744
Fax Number	:	941-429-4754

Provider Business Practice Location Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT E
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:	941-429-4744
Fax Number	:	941-429-5754

Authorized Official
Title or Position	:	OWNER
Name	:	GIRISH D PATEL
Credential	:	MD
Telephone Number	:	941-429-4744

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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