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General NPI Number Information
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NPI Number | 1982860656
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Entity Type | Organization
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Legal Business Name | LEESBURG PRIMARY CARE CENTER, LLC
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 620 S LAKE ST UNIT 5
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City | LEESBURG
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State | FL
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Zip | 34748-6059
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Country | US
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Telephone | 352-319-6810
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Fax | 352-365-9673
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Provider Business Mailing Address
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Address Line | 620 S LAKE ST UNIT 5
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City | LEESBURG
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State | FL
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Zip | 34748-6059
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Country | US
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Telephone | 352-319-6810
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Fax | 352-365-9673
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MRS. NARMATA A AMIN
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Credential |
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Telephone | 727-251-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME67237
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License Number State | FL
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