MEDICARE: CHARLOTTE COUNTY PRIMARY CARE PA

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215937735	OTHER	FL	NPI OTHER LOCATION

General Provider Information

NPI Number	:	1285849141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE COUNTY PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	PO BOX 380639
Second Line	:
City	:	MURDOCK
State	:	FL
Zip	:	33938-0639
Country	:	US
Telephone Number	:	941-613-1700
Fax Number	:	941-258-3370

Provider Business Practice Location Address
First Line	:	3067 TAMIAMI TRL
Second Line	:	UNIT 3
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6601
Country	:	US
Telephone Number	:	941-613-1700
Fax Number	:	941-258-3370

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE M GARCIA
Credential	:	MD
Telephone Number	:	941-613-1700

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/13/2008

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Directions to “CHARLOTTE COUNTY PRIMARY CARE PA ” Practice Location

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