| Md Primary Care Inc | |
|
2215 Nebraska Ave Ste 2-b Fort Pierce FL 34950-4866 | |
| (772) 302-3767 | |
| (888) 436-7197 |
| Full Name | Md Primary Care Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2215 Nebraska Ave Ste 2-b, Fort Pierce, Florida |
| Authorized Official Name and Position | Chintan B Shah (CEO) |
| Authorized Official Contact | 6193986333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Md Primary Care Inc 8113 Kiawah Trce Port St Lucie FL 34986-3026 Ph: (619) 398-6333 | Md Primary Care Inc 2215 Nebraska Ave Ste 2-b Fort Pierce FL 34950-4866 Ph: (772) 302-3767 |
| NPI Number | 1033766027 |
|---|---|
| Provider Enumeration Date | 08/23/2019 |
| Last Update Date | 08/23/2019 |
| Medicare PECOS PAC ID | 2163753401 |
|---|---|
| Medicare Enrollment ID | O20191017000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033766027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Chintan B Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871782268 PECOS PAC ID: 8921124736 Enrollment ID: I20100929001459 |
| Provider Name | Sherise M Stark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669022505 PECOS PAC ID: 5991037798 Enrollment ID: I20191029000082 |
| Provider Name | Jessica Jeanlouis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982216743 PECOS PAC ID: 4688093891 Enrollment ID: I20201007000908 |
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