Healthcare Provider Details

I. General information

NPI: 1487319281
Provider Name (Legal Business Name): CARBON HEALTH PRIMARY CARE OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 WELSH RD
DRESHER PA
19025-5502
US

IV. Provider business mailing address

300 CALIFORNIA ST FL 7
SAN FRANCISCO CA
94104-1415
US

V. Phone/Fax

Practice location:
  • Phone: 267-434-1107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR
Credential:
Phone: 417-861-9739