MEDICARE: THE PRIMARY CARE CENTER OF LAKE CITY RICHARD L. WRIGHT JR MD, PA

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	208D00000X	General Practice Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF1648	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	240513	OTHER	FL	AVMED
3	12045	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1366460297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PRIMARY CARE CENTER OF LAKE CITY RICHARD L. WRIGHT JR MD, PA

Provider Business Mailing Address
First Line	:	221 SW STONEGATE TER STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3463
Country	:	US
Telephone Number	:	386-755-0421
Fax Number	:	877-698-9577

Provider Business Practice Location Address
First Line	:	221 SW STONEGATE TER STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3463
Country	:	US
Telephone Number	:	386-755-0421
Fax Number	:	386-487-1234

Authorized Official
Title or Position	:	OFFICE MANAGER/CFO
Name	:	SARA WRIGHT
Credential	:
Telephone Number	:	386-755-0421

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/08/2025

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