Healthcare Provider Details

I. General information

NPI: 1285175901
Provider Name (Legal Business Name): PRIME CARE FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 ARLINGTON ST
ORLANDO FL
32805-1310
US

IV. Provider business mailing address

9780 E INDIGO ST SUITE 202
PALMETTO BAY FL
33157-5609
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-5343
  • Fax: 407-648-5023
Mailing address:
  • Phone: 305-252-9485
  • Fax: 305-252-9486

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND LEVY
Title or Position: PRESIDENT
Credential:
Phone: 305-252-9485