Provider Demographics
NPI:1164864617
Name:PATIENT ALIGNED PRIMARY CARE CENTER, LLC
Entity Type:Organization
Organization Name:PATIENT ALIGNED PRIMARY CARE CENTER, LLC
Other - Org Name:AFTER HOURS PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-506-8910
Mailing Address - Street 1:PO BOX 730096
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0096
Mailing Address - Country:US
Mailing Address - Phone:386-506-8910
Mailing Address - Fax:
Practice Address - Street 1:909 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2517
Practice Address - Country:US
Practice Address - Phone:386-506-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96367207Q00000X
FLME 107681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty