Provider Demographics
NPI:1366460297
Name:THE PRIMARY CARE CENTER OF LAKE CITY RICHARD L. WRIGHT JR MD
Entity Type:Organization
Organization Name:THE PRIMARY CARE CENTER OF LAKE CITY RICHARD L. WRIGHT JR MD
Other - Org Name:HEALTH CARE INSTITUTE OF NORTH FLORIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-755-0421
Mailing Address - Street 1:221 SW STONEGATE TER STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3463
Mailing Address - Country:US
Mailing Address - Phone:386-755-0421
Mailing Address - Fax:386-487-1234
Practice Address - Street 1:221 SW STONEGATE TER STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3463
Practice Address - Country:US
Practice Address - Phone:386-755-0421
Practice Address - Fax:386-487-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF1648OtherRAILROAD MEDICARE
FL12045OtherBCBS
FL240513OtherAVMED
FLDF1648OtherRAILROAD MEDICARE