Provider Demographics
NPI:1518177930
Name:PRIMACARE HEALTH CENTERS INC
Entity Type:Organization
Organization Name:PRIMACARE HEALTH CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
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:727-823-4880
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:727-823-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH520Medicare PIN