Provider Demographics
NPI:1659114577
Name:YOUR HEALTH PRIMARY CARE OF FLORIDA, LLC
Entity type:Organization
Organization Name:YOUR HEALTH PRIMARY CARE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-730-8910
Mailing Address - Street 1:111 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:803-457-5129
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 303B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3117
Practice Address - Country:US
Practice Address - Phone:803-457-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care