Provider Demographics
NPI:1801497953
Name:WILDWOOD PRIMARY CARE ASSOCIATES
Entity type:Organization
Organization Name:WILDWOOD PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-269-6426
Mailing Address - Street 1:5814 SEVEN MILE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-8869
Mailing Address - Country:US
Mailing Address - Phone:813-269-6426
Mailing Address - Fax:
Practice Address - Street 1:5814 SEVEN MILE DR STE 105
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8869
Practice Address - Country:US
Practice Address - Phone:813-269-6426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty