Provider Demographics
NPI:1083873897
Name:PRIMARY CARE PHYSICIANS OF SANFORD LLC
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF SANFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-324-5035
Mailing Address - Street 1:309 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1205
Mailing Address - Country:US
Mailing Address - Phone:407-324-5035
Mailing Address - Fax:407-321-5266
Practice Address - Street 1:309 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1205
Practice Address - Country:US
Practice Address - Phone:407-324-5035
Practice Address - Fax:407-321-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6401207Q00000X
FLOS6404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty