Provider Demographics
NPI:1700204120
Name:PRIMARY CARE AND WELLNESS CENTER OF FLORIDA
Entity Type:Organization
Organization Name:PRIMARY CARE AND WELLNESS CENTER OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-880-4505
Mailing Address - Street 1:PO BOX 551586
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1586
Mailing Address - Country:US
Mailing Address - Phone:904-880-4505
Mailing Address - Fax:
Practice Address - Street 1:8075 GATE PKWY W STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3685
Practice Address - Country:US
Practice Address - Phone:904-880-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty