| Rl2imc, Pllc | |
|
584 Nw University Blvd Ste 370 Port St Lucie FL 34986-2268 | |
| (586) 252-0069 | |
| Not Available |
| Full Name | Rl2imc, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 584 Nw University Blvd Ste 370, Port St Lucie, Florida |
| Authorized Official Name and Position | Raymond Timothy Larocque (OWNER) |
| Authorized Official Contact | 5862520069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rl2imc, Pllc 584 Nw University Blvd Ste 370 Port St Lucie FL 34986-2268 Ph: (586) 252-0069 | Rl2imc, Pllc 584 Nw University Blvd Ste 370 Port St Lucie FL 34986-2268 Ph: (586) 252-0069 |
| NPI Number | 1164235024 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 01/27/2025 |
| Medicare PECOS PAC ID | 3577085117 |
|---|---|
| Medicare Enrollment ID | O20250324001566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164235024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Raymond Larocque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982081683 PECOS PAC ID: 8426356429 Enrollment ID: I20230323002659 |
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