PRIMECARE PL NPI 1407038169

NPI Information

NPI: 1407038169
Provider Name: PRIMECARE PL
Classification: Internal Medicine - 207RC0000X
Entity Type: Organization

Specialization: Cardiovascular Disease

CLIA Number: 10D1032877

Address:
2720 US HIGHWAY 1 S # B
ST AUGUSTINE, FL
ZIP 32086
Phone: (904) 827-0078
Get Directions

PRIMECARE PL is a cardiovascular disease internal medicine in St Augustine, FL. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. PRIMECARE PL NPI is 1407038169. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2720 US HIGHWAY 1 S # B
ST AUGUSTINE, FL
ZIP 32086-301
Phone: (904) 827-0078
Fax: (904) 827-0140

The provider's authorized official is Robert C Kelsey .
The authorized official title is President and has the following contact phone number (904) 827-0078.

The CLIA number assigned to this NPI record is 10D1032877 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/4/2007 and was last updated on 11/18/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	ME58662	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	270845106	MEDICAID	FLORIDA
2	270845105	MEDICAID	FLORIDA
3	270845104	MEDICAID	FLORIDA
4	270845101	MEDICAID	FLORIDA
5	97705	OTHER	FLORIDA	BCBS
6	AI041	MEDICARE PIN	FLORIDA
7	270845102	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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