Provider Demographics
NPI:1174863476
Name:PRIMARY CARE ON CALL, INC
Entity Type:Organization
Organization Name:PRIMARY CARE ON CALL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-322-2472
Mailing Address - Street 1:9838 OLD BAYMEADOWS RD
Mailing Address - Street 2:#283
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-472-0537
Mailing Address - Fax:904-551-6597
Practice Address - Street 1:9838 OLD BAYMEADOWS RD
Practice Address - Street 2:#283
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8101
Practice Address - Country:US
Practice Address - Phone:904-472-0537
Practice Address - Fax:904-551-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9208913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1039346OtherWORKERS COMPENSATION
FL1490727OtherGWH
FL1490727OtherCIGNA
FL1490727OtherCIGNA