Provider Demographics
NPI:1386042703
Name:QUALITY PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:QUALITY PRIMARY CARE PLLC
Other - Org Name:QUALITY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-466-3399
Mailing Address - Street 1:514 MARY ESTHER CUT OFF NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4025
Mailing Address - Country:US
Mailing Address - Phone:850-466-3399
Mailing Address - Fax:850-226-6712
Practice Address - Street 1:514 MARY ESTHER CUT OFF NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4025
Practice Address - Country:US
Practice Address - Phone:850-466-3399
Practice Address - Fax:850-226-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265037100Medicaid
AL009911303Medicaid
AL510I930013Medicare PIN
FL17358Medicare PIN
FL265037100Medicaid