MEDICARE: PATIENTS FIRST FAMILY PRACTICE AND URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073828984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENTS FIRST FAMILY PRACTICE AND URGENT CARE LLC

Provider Business Mailing Address
First Line	:	409 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-582-5433
Fax Number	:	561-585-0074

Provider Business Practice Location Address
First Line	:	409 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4442
Country	:	US
Telephone Number	:	561-582-5433
Fax Number	:	561-585-0074

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JANET W RADFORD
Credential	:	ARNP
Telephone Number	:	561-452-8580

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	03/22/2013

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