Healthcare Provider Details

I. General information

NPI: 1225628803
Provider Name (Legal Business Name): NEWCARE PRIMARY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 W US HIGHWAY 90
LAKE CITY FL
32055-8835
US

IV. Provider business mailing address

4551 W US HIGHWAY 90
LAKE CITY FL
32055-8835
US

V. Phone/Fax

Practice location:
  • Phone: 386-319-8178
  • Fax: 386-243-8786
Mailing address:
  • Phone: 386-319-8178
  • Fax: 386-243-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH K NEWMAN
Title or Position: OWNER
Credential: APRN
Phone: 386-319-8178