=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366460297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PRIMARY CARE CENTER OF LAKE CITY RICHARD L. WRIGHT JR MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 SW STONEGATE TER STE 101
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32024-3463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-755-0421
-----------------------------------------------------
Fax | 386-487-1234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 SW STONEGATE TER STE 101
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32024-3463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-755-0421
-----------------------------------------------------
Fax | 877-698-9577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/CFO
-----------------------------------------------------
Name | SARA WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-755-0421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------