Provider Demographics
NPI:1558606335
Name:PRIMARY CARE OF GAINESVILLE LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF GAINESVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMADRID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-505-0255
Mailing Address - Street 1:1026 SW 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8182
Mailing Address - Country:US
Mailing Address - Phone:352-505-0255
Mailing Address - Fax:352-505-0997
Practice Address - Street 1:1026 SW 2ND AVE STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8182
Practice Address - Country:US
Practice Address - Phone:352-505-0255
Practice Address - Fax:352-505-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN101261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care