Provider Demographics
NPI:1982258422
Name:LATUS PRIMARY CARE MEDICINE, PLLC DBA LATUS MEDICAL CARE
Entity Type:Organization
Organization Name:LATUS PRIMARY CARE MEDICINE, PLLC DBA LATUS MEDICAL CARE
Other - Org Name:LATUS MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:SMERING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-304-4683
Mailing Address - Street 1:2350 MAPLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4080
Mailing Address - Country:US
Mailing Address - Phone:716-688-6500
Mailing Address - Fax:716-688-6501
Practice Address - Street 1:2350 MAPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-4080
Practice Address - Country:US
Practice Address - Phone:716-688-6500
Practice Address - Fax:716-688-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care