MEDICARE: FITST CHOIE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1710199039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITST CHOIE PRIMARY CARE,LLC

Provider Business Mailing Address
First Line	:	2431 ALOMA AVE STE 111
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2522
Country	:	US
Telephone Number	:	407-737-8780
Fax Number	:	407-737-8517

Provider Business Practice Location Address
First Line	:	1154 LEE BLVD
Second Line	:	SUITE 4
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4852
Country	:	US
Telephone Number	:	239-369-6211
Fax Number	:	239-369-1209

Authorized Official
Title or Position	:	CEO
Name	:	MR. WLILLIE PIERRE
Credential	:
Telephone Number	:	239-745-1228

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	12/21/2007

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