Provider Demographics
NPI:1982860656
Name:LEESBURG PRIMARY CARE CENTER, LLC
Entity Type:Organization
Organization Name:LEESBURG PRIMARY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NARMATA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-251-1366
Mailing Address - Street 1:620 S LAKE ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6059
Mailing Address - Country:US
Mailing Address - Phone:352-319-6810
Mailing Address - Fax:352-365-9673
Practice Address - Street 1:620 S LAKE ST
Practice Address - Street 2:UNIT 5
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6059
Practice Address - Country:US
Practice Address - Phone:352-319-6810
Practice Address - Fax:352-365-9673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-01
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty