Provider Demographics
NPI:1073709333
Name:PATIENTS PRIMARY CARE LLC
Entity Type:Organization
Organization Name:PATIENTS PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FACKLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-629-8088
Mailing Address - Street 1:PO BOX 771706
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-1706
Mailing Address - Country:US
Mailing Address - Phone:352-629-8088
Mailing Address - Fax:352-629-1962
Practice Address - Street 1:4413 NW BLITCHTON RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-4056
Practice Address - Country:US
Practice Address - Phone:352-629-8088
Practice Address - Fax:352-629-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPOO269817OtherMEDICARE RAILROAD
FLK8362Medicare PIN