Provider Demographics
NPI:1760101513
Name:CARBON HEALTH PRIMARY CARE OF FLORIDA PA
Entity Type:Organization
Organization Name:CARBON HEALTH PRIMARY CARE OF FLORIDA PA
Other - Org Name:CARBON HEALTH PRIMARY CARE OF FLORIDA PA
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-894-1718
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6572 E GRANT RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3810
Practice Address - Country:US
Practice Address - Phone:520-300-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON HEALTH PRIMARY CARE OF FLORIDA PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-24
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care