Provider Demographics
NPI:1063963130
Name:HOLY CROSS PRIMARY CARE, INC
Entity type:Organization
Organization Name:HOLY CROSS PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-3792
Mailing Address - Street 1:PO BOX 70700
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-0700
Mailing Address - Country:US
Mailing Address - Phone:954-351-4702
Mailing Address - Fax:
Practice Address - Street 1:8190 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5706
Practice Address - Country:US
Practice Address - Phone:954-344-6537
Practice Address - Fax:954-344-2818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY CROSS PRIMARY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIQ434AMedicare PIN