=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427517531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME CARE FAMILY HEALTH CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2019
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1747 45TH ST
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-508-8609
-----------------------------------------------------
Fax | 561-508-8697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9780 E INDIGO ST STE 202
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-5610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-804-7947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAYMOND LEVY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-252-9485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------