Provider Demographics
NPI:1396229605
Name:PRIMACARE EMC, INC.
Entity Type:Organization
Organization Name:PRIMACARE EMC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-823-4848
Mailing Address - Street 1:3236 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1202
Mailing Address - Country:US
Mailing Address - Phone:727-823-4848
Mailing Address - Fax:
Practice Address - Street 1:3236 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1202
Practice Address - Country:US
Practice Address - Phone:727-823-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care