1639277502 NPI number — FIRST PRIMARY CARE & FAMILY MEDICINE INC

Table of content: (NPI 1639277502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639277502 NPI number — FIRST PRIMARY CARE & FAMILY MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST PRIMARY CARE & FAMILY MEDICINE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIGIEXPRESS IMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639277502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2587 WOODGROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLEMING ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32003-4974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-264-0286
Provider Business Mailing Address Fax Number:
904-264-0296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2587 WOODGROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMING ISLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32003-4974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-264-0286
Provider Business Practice Location Address Fax Number:
904-264-0296
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANG
Authorized Official First Name:
HUI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
904-264-0286

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME85064 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X , with the licence number: HCC7670 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W9969 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 003760500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".