Provider Demographics
NPI:1790799526
Name:PRIMARY MEDICAL CARE R AYALA MD PA
Entity Type:Organization
Organization Name:PRIMARY MEDICAL CARE R AYALA MD PA
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:COMFORT-MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-853-7822
Mailing Address - Street 1:13438 FORT KING RD.
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5214
Mailing Address - Country:US
Mailing Address - Phone:352-567-5266
Mailing Address - Fax:352-567-3066
Practice Address - Street 1:13438 FORT KING RD.
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5214
Practice Address - Country:US
Practice Address - Phone:352-567-5266
Practice Address - Fax:352-567-3066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY MEDICAL CARE R AYALA MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72656EMedicare PIN
FL72656Medicare PIN
FL72656,72656EMedicare PIN
FL72656,72656EMedicare PIN
FL72656AMedicare PIN