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NPI Code Detail

MEDICARE: PRIMARY CARE OF VENICE LLC

MEDICARE: PRIMARY CARE OF VENICE LLC
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
1261QP2300XPrimary Care Clinic/Center
2261QU0200XUrgent Care Clinic/Center
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1588445753
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE OF VENICE LLC
Provider Business Mailing Address
First Line : 1370 E VENICE AVE STE 102B
Second Line :
City : VENICE
State : FL
Zip : 34285-9083
Country : US
Telephone Number : 727-300-0063
Fax Number : 727-954-6546
Provider Business Practice Location Address
First Line : 1370 E VENICE AVE STE 102B
Second Line :
City : VENICE
State : FL
Zip : 34285-9083
Country : US
Telephone Number : 77-248-9604
Fax Number :
Authorized Official
Title or Position : CEO
Name : ZAID ALI
Credential :
Telephone Number : 407-724-8960
Provider Enumeration Date : 10/12/2023
Last Update Date : 04/03/2024

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Directions to “PRIMARY CARE OF VENICE LLC ” Practice Location

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