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General NPI Number Information
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NPI Number | 1790793016
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Entity Type | Organization
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Legal Business Name | LIFETIME MEDICAL CARE PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 2300 PARK AVE SUITE 203
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City | ORANGE PARK
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State | FL
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Zip | 32073-5571
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Country | US
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Telephone | 904-278-0016
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Fax | 904-278-4217
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Provider Business Mailing Address
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Address Line | 5000 US HIGHWAY 17 SUITE 18-302
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City | ORANGE PARK
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State | FL
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Zip | 32003-8231
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Country | US
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Telephone | 904-278-0016
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Fax | 904-278-4217
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIDAL EL RIMAWI
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Credential | M.D.
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Telephone | 904-278-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME81222
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License Number State | FL
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