MEDICARE: ACE PRIMARY CARE 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	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1588445514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	1407 E ALLEGRIE DR
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34453-3658
Country	:	US
Telephone Number	:	810-406-7175
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SE 5TH TER STE 2
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-4865
Country	:	US
Telephone Number	:	352-462-4334
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALISTAIR CO
Credential	:	MD
Telephone Number	:	352-462-4334

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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Directions to “ACE PRIMARY CARE LLC ” Practice Location

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