Provider Demographics
NPI:1558694422
Name:PHYSICIANS PRIMARY CARE LLC
Entity Type:Organization
Organization Name:PHYSICIANS PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-213-1776
Mailing Address - Street 1:9826 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5438
Mailing Address - Country:US
Mailing Address - Phone:904-262-9444
Mailing Address - Fax:
Practice Address - Street 1:2020 KINGSLEY AVE STE D
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5139
Practice Address - Country:US
Practice Address - Phone:904-213-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care