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General NPI Number Information
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NPI Number | 1992457444
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Entity Type | Organization
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Legal Business Name | MEDICS PRIMARY CARE
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 484 SW COMMERCE DR STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-1508
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Country | US
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Telephone | 386-406-2577
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Fax | 855-618-2462
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Provider Business Mailing Address
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Address Line | 484 SW COMMERCE DR STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-1508
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Country | US
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Telephone | 386-406-2577
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANNETTE JULISSA GANDIA-MORALES
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Credential |
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Telephone | 386-406-2577
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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 |
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License Number State |
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