Organization Name: | MEDEX PRIMARY CARE |
NPI Number: | 1174892830 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LYNN H. DENNIS (OFFICE ADMINISTRATOR) |
Mailing Address: | 6500 Crill Ave Bldg 3 Ste 1 Palatka |
State: | FL US |
Postal Code: | 321779230 |
Phone Number: | 3863260575 |
Fax Number: | 3863260571 |
NPI Enumeration Date: | 12/23/2011 |
NPI Last Update Date: | 12/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | ME54477 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |