MEDICARE: ST LUCIE MEDICAL ASSOCIATES INC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1265681019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUCIE MEDICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1701 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-335-3184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-335-3184
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BINNO DHAR
Credential	:	M.D.
Telephone Number	:	772-335-3184

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	11/21/2008

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