=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558726802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMECARE DOCTORS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2015
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9030 W FORT ISLAND TRL STE 1
-----------------------------------------------------
City | CRYSTAL RIVER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34429-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-228-8906
-----------------------------------------------------
Fax | 352-228-8905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1214 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-796-9994
-----------------------------------------------------
Fax | 352-796-9934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PARIKSITH SINGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-796-9994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME71088
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------