MEDICARE: PEOPLES MEDICAL CENTERS PRIMARY CARE INC

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	261QP2300X	Primary Care Clinic/Center

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	:	1194033043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLES MEDICAL CENTERS PRIMARY CARE INC

Provider Business Mailing Address
First Line	:	4114 SUNBEAM RD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8870
Country	:	US
Telephone Number	:	904-262-9444
Fax Number	:	904-262-3750

Provider Business Practice Location Address
First Line	:	4114 SUNBEAM RD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8870
Country	:	US
Telephone Number	:	904-262-9444
Fax Number	:	904-262-3750

Authorized Official
Title or Position	:	C.E.O.
Name	:	MICHAEL CRITZER
Credential	:
Telephone Number	:	904-262-9444

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	10/28/2019

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