MEDICARE: LMDC PRIMARY MEDICINE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1275266389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LMDC PRIMARY MEDICINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 560
Second Line	:
City	:	HATILLO
State	:	PR
Zip	:	00659-0560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 CALLE SAN FELIPE
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4605
Country	:	US
Telephone Number	:	787-879-3995
Fax Number	:

Authorized Official
Title or Position	:	PRIMARY CARE PHYSICIAN
Name	:	LORENA MICHELLE DIAZ COLON
Credential	:	MD
Telephone Number	:	787-879-3995

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	06/15/2024

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