Provider Demographics
NPI:1437894466
Name:STEAD PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:STEAD PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEAD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-367-1200
Mailing Address - Street 1:3060 TAMIAMI TRL N STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2749
Mailing Address - Country:US
Mailing Address - Phone:239-367-1200
Mailing Address - Fax:239-367-1220
Practice Address - Street 1:3060 TAMIAMI TRL N STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2749
Practice Address - Country:US
Practice Address - Phone:239-367-1200
Practice Address - Fax:239-367-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care