| Island Direct Primary Care Llc | |
|
390 N Courtenay Pkwy Merritt Island FL 32953-3456 | |
| (321) 506-2540 | |
| Not Available |
| Full Name | Island Direct Primary Care Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 390 N Courtenay Pkwy, Merritt Island, Florida |
| Authorized Official Name and Position | John Wesley Rothwell (PRESIDENT) |
| Authorized Official Contact | 3215062540 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Direct Primary Care Llc 210 Hickory Ave Merritt Island FL 32953-4368 Ph: (321) 506-2540 | Island Direct Primary Care Llc 390 N Courtenay Pkwy Merritt Island FL 32953-3456 Ph: (321) 506-2540 |
| NPI Number | 1811463961 |
|---|---|
| Provider Enumeration Date | 10/16/2018 |
| Last Update Date | 03/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811463961 | NPI | - | NPPES |
| 1679943740 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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