| Organization Name: | PRIMECARE AT TWIN LAKES LLC |
| NPI Number: | 1104072594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES D DUVA (PRESIDENT) |
| Mailing Address: | 740 Dunlawton Ave Suite 100 Port Orange |
| State: | FL US |
| Postal Code: | 321274239 |
| Phone Number: | 3862742212 |
| Fax Number: | 3862741508 |
| NPI Enumeration Date: | 08/18/2008 |
| NPI Last Update Date: | 05/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 10698 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |