Provider Demographics
NPI:1477717544
Name:PRIME CARE FAMILY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:PRIME CARE FAMILY HEALTH CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-880-0800
Mailing Address - Street 1:1706 E SEMORAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5610
Mailing Address - Country:US
Mailing Address - Phone:407-880-0800
Mailing Address - Fax:407-880-0808
Practice Address - Street 1:1706 E SEMORAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5610
Practice Address - Country:US
Practice Address - Phone:407-880-0800
Practice Address - Fax:407-880-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02780Medicare PIN