MEDICARE: PRIMACARE 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	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	:	1518177930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMACARE HEALTH CENTERS INC

Provider Business Mailing Address
First Line	:	3236 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	727-823-4848
Fax Number	:	727-823-4880

Provider Business Practice Location Address
First Line	:	3236 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	727-823-4848
Fax Number	:	727-823-4880

Authorized Official
Title or Position	:	PARTNER
Name	:	JOHN WHEELER
Credential	:	ARNP
Telephone Number	:	727-823-4848

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	02/18/2014

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Directions to “PRIMACARE HEALTH CENTERS INC ” Practice Location

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