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General NPI Number Information
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NPI Number | 1174863476
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE ON CALL, INC
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 9838 OLD BAYMEADOWS RD #283
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8101
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Country | US
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Telephone | 904-472-0537
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Fax | 904-551-6597
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Provider Business Mailing Address
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Address Line | 9838 OLD BAYMEADOWS RD #283
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8101
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Country | US
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Telephone | 904-472-0537
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Fax | 904-551-6597
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT M LANCASTER
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Credential | ARNP
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Telephone | 904-322-2472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9208913
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License Number State | FL
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