MEDICARE: VA PRIMARY CARE CLINIC

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	261Q00000X	Clinic/Center	SW7718	FL

General Provider Information

NPI Number	:	1891775581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA PRIMARY CARE CLINIC

Provider Business Mailing Address
First Line	:	727 N US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9125
Country	:	US
Telephone Number	:	772-595-5150
Fax Number	:	772-595-6560

Provider Business Practice Location Address
First Line	:	727 N US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9125
Country	:	US
Telephone Number	:	772-595-5150
Fax Number	:	772-595-6560

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. CAROLE BETH EILENBERG
Credential	:	LCSW
Telephone Number	:	772-595-5150

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/22/2020

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Directions to “VA PRIMARY CARE CLINIC ” Practice Location

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