Vital Primary Care Llc | |
12640 World Plaza Ln Bldg 71 Fort Myers FL 33907-3987 | |
(786) 340-0260 | |
Not Available |
Full Name | Vital Primary Care Llc |
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Speciality | Clinic/Center |
Location | 12640 World Plaza Ln Bldg 71, Fort Myers, Florida |
Authorized Official Name and Position | Niels Moleiro (CFO) |
Authorized Official Contact | 7863400260 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Vital Primary Care Llc 12640 World Plaza Ln Bldg 71 Fort Myers FL 33907-3987 Ph: (786) 340-0260 | Vital Primary Care Llc 12640 World Plaza Ln Bldg 71 Fort Myers FL 33907-3987 Ph: (786) 340-0260 |
NPI Number | 1427882414 |
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Provider Enumeration Date | 08/30/2024 |
Last Update Date | 02/27/2025 |
Medicare PECOS PAC ID | 1254870512 |
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Medicare Enrollment ID | O20240829004708 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427882414 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Miriam Garcia Portela |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1407865504 PECOS PAC ID: 6406932524 Enrollment ID: I20080328000453 |
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