Healthcare Provider Details

I. General information

NPI: 1063963130
Provider Name (Legal Business Name): HOLY CROSS PRIMARY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8190 ROYAL PALM BLVD SUITE 100
CORAL SPRINGS FL
33065-5706
US

IV. Provider business mailing address

PO BOX 70700
FT LAUDERDALE FL
33307-0700
US

V. Phone/Fax

Practice location:
  • Phone: 954-344-6537
  • Fax: 954-344-2818
Mailing address:
  • Phone: 954-351-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CASALOU
Title or Position: PRESIDENT & CEO
Credential:
Phone: 734-712-3792