Provider Demographics
NPI:1861026833
Name:MEDI PRIME CARE LLC
Entity Type:Organization
Organization Name:MEDI PRIME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-482-7540
Mailing Address - Street 1:109 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5203
Mailing Address - Country:US
Mailing Address - Phone:813-235-4090
Mailing Address - Fax:813-774-3804
Practice Address - Street 1:1450 COURT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-6160
Practice Address - Country:US
Practice Address - Phone:727-222-6016
Practice Address - Fax:813-774-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care