Provider Demographics
NPI:1033766027
Name:MD PRIMARY CARE INC
Entity Type:Organization
Organization Name:MD PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINTAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-398-6333
Mailing Address - Street 1:8113 KIAWAH TRCE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3026
Mailing Address - Country:US
Mailing Address - Phone:619-398-6333
Mailing Address - Fax:888-436-7197
Practice Address - Street 1:2215 NEBRASKA AVE STE 2-B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4866
Practice Address - Country:US
Practice Address - Phone:772-302-3767
Practice Address - Fax:888-436-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty