Provider Demographics
NPI:1942949086
Name:MEDICAL SPA AND PRIMARY CARE OF OCALA
Entity Type:Organization
Organization Name:MEDICAL SPA AND PRIMARY CARE OF OCALA
Other - Org Name:EXPRESS CARE OF OCALA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-9888
Mailing Address - Street 1:1813 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8167
Mailing Address - Country:US
Mailing Address - Phone:352-732-7188
Mailing Address - Fax:352-355-2132
Practice Address - Street 1:1813 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8167
Practice Address - Country:US
Practice Address - Phone:352-732-7188
Practice Address - Fax:352-355-2132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B & J EXPRESS CARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-27
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty