Provider Demographics
NPI:1407555154
Name:PRIMARY CARE SOLUTIONS JACKSONVILLE LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SOLUTIONS JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-490-0264
Mailing Address - Street 1:42 DAVIN CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1840
Mailing Address - Country:US
Mailing Address - Phone:904-490-0264
Mailing Address - Fax:
Practice Address - Street 1:42 DAVIN CT
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1840
Practice Address - Country:US
Practice Address - Phone:904-490-0264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty