MEDICARE: PRIME CARE FAMILY HEALTH CENTERS 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	207Q00000X	Family Medicine Physician	ME48249	FL

General Provider Information

NPI Number	:	1477717544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE FAMILY HEALTH CENTERS INC

Provider Business Mailing Address
First Line	:	1706 E SEMORAN BLVD STE 101
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5610
Country	:	US
Telephone Number	:	407-880-0800
Fax Number	:	407-880-0808

Provider Business Practice Location Address
First Line	:	1706 E SEMORAN BLVD STE 101
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5610
Country	:	US
Telephone Number	:	407-880-0800
Fax Number	:	407-880-0808

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARYSE NAU
Credential	:
Telephone Number	:	407-880-0800

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	08/18/2008

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