| Primecare Medical Clinic, Pa | |
|
2869 Wilshire Dr Suite 205 Orlando FL 32835-3282 | |
| (407) 295-0500 | |
| (407) 290-2997 |
| Full Name | Primecare Medical Clinic, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2869 Wilshire Dr, Orlando, Florida |
| Authorized Official Name and Position | Mohammed Ak Moosa (PRESIDENT) |
| Authorized Official Contact | 4078305080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Medical Clinic, Pa 2869 Wilshire Dr Suite 205 Orlando FL 32835-3282 Ph: (407) 295-0500 | Primecare Medical Clinic, Pa 2869 Wilshire Dr Suite 205 Orlando FL 32835-3282 Ph: (407) 295-0500 |
| NPI Number | 1861688814 |
|---|---|
| Provider Enumeration Date | 09/23/2007 |
| Last Update Date | 05/06/2010 |
| Medicare PECOS PAC ID | 9830112713 |
|---|---|
| Medicare Enrollment ID | O20060105000834 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861688814 | NPI | - | NPPES |
| 42524A | Other | FL | INDIVIDUAL MC PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME73277 (Florida) | Primary |
| Provider Name | Mohammed Moosa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437268620 PECOS PAC ID: 2769475979 Enrollment ID: I20090716000122 |
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