Provider Demographics
NPI:1639643596
Name:ENVISION PRIMARY HEALTHCARE LLC
Entity Type:Organization
Organization Name:ENVISION PRIMARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-712-3380
Mailing Address - Street 1:221 N HOGAN ST # 335
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:904-712-3380
Mailing Address - Fax:
Practice Address - Street 1:7317 STEVENTON WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8179
Practice Address - Country:US
Practice Address - Phone:904-712-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty