Provider Demographics
NPI:1609197920
Name:FLORIDA PRIMARY CARE CENTER, PA
Entity Type:Organization
Organization Name:FLORIDA PRIMARY CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-7791
Mailing Address - Street 1:15493 STONEYBROOK WEST PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4769
Mailing Address - Country:US
Mailing Address - Phone:407-299-7791
Mailing Address - Fax:
Practice Address - Street 1:15493 STONEYBROOK WEST PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4769
Practice Address - Country:US
Practice Address - Phone:407-299-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48001261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care