Provider Demographics
NPI:1922625060
Name:WELLINGTON PRIMARY CARE LLC
Entity Type:Organization
Organization Name:WELLINGTON PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-334-8988
Mailing Address - Street 1:12959 PALMS WEST DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4940
Mailing Address - Country:US
Mailing Address - Phone:561-334-8988
Mailing Address - Fax:
Practice Address - Street 1:12959 PALMS WEST DR STE 210
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4940
Practice Address - Country:US
Practice Address - Phone:561-334-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty