MEDICARE: LATUS PRIMARY CARE MEDICINE, PLLC DBA LATUS MEDICAL CARE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1982258422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATUS PRIMARY CARE MEDICINE, PLLC DBA LATUS MEDICAL CARE

Provider Business Mailing Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:	716-688-6501

Provider Business Practice Location Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:	716-688-6501

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. PEGGY DAVIS SMERING
Credential	:	RN
Telephone Number	:	716-304-4683

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	05/05/2021

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