| Premium Primary Care & Walk-in Clinic Inc | |
|
1801 Se Hillmoor Dr Unit A-107p Port St Lucie FL 34952-7553 | |
| (772) 446-0950 | |
| (772) 446-0956 |
| Full Name | Premium Primary Care & Walk-in Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1801 Se Hillmoor Dr Unit A-107p, Port St Lucie, Florida |
| Authorized Official Name and Position | Patrick A Vergel De Dios (APRN) |
| Authorized Official Contact | 7724460950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Primary Care & Walk-in Clinic Inc 1801 Se Hillmoor Dr Unit A-107p Port St Lucie FL 34952-7553 Ph: (772) 446-0950 | Premium Primary Care & Walk-in Clinic Inc 1801 Se Hillmoor Dr Unit A-107p Port St Lucie FL 34952-7553 Ph: (772) 446-0950 |
| NPI Number | 1700654167 |
|---|---|
| Provider Enumeration Date | 12/15/2023 |
| Last Update Date | 12/15/2023 |
| Medicare PECOS PAC ID | 7113377656 |
|---|---|
| Medicare Enrollment ID | O20231227000432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700654167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Patrick Vergel De Dios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760993786 PECOS PAC ID: 9931466216 Enrollment ID: I20171121001494 |
| Provider Name | Srinivas Boppana |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679839252 PECOS PAC ID: 1355667064 Enrollment ID: I20180621002542 |
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